
Class ST^.3 
Book. , L4 _ 



JO 



Copyright H! 

coehucht DEPosrr. 




10 








Longitudinal 


section of the eyeball. 


1. 


Cornea. 


10. Choroid. 


2. 


Anterior chamber. 


11. Retina. 


3. 


Pupil. 


12. Vena vorticosa. 


4. 


Lens capsule. 


13. Hyaline membrane. 


5. 


Lens. 


14. Vitreous. 


6. 


Iris. 


15. Posterior ciliary arteries 


7. 


Ciliary ligament. 


16. Macula lutea. 


8. 


Ciliary process. 


17. Optic nerve. 


9. 


Sclera. 





The 

Ophthalmic Nurse 



By 
G. Griffin Lewis, M. D., F. A. C. S. 

Syracuse, N. Y. 

Oculist to Crouse-Irving Hospital 

To St. Mary's Maternity Hospital 

To St. Vincent's Asylum 



With 102 Illustrations 



Philadelphia and London 

W. B. Saunders Company 

1920 






Copyright, 1920, by W. B. Saunders Company 









PRINTED IN AMERICA 



PRE88 OF 

W. B. SAUNDERS COMPANY 

PHILADELPHIA 

MAY 2 
5)C!.A571024 



PREFACE 



This little volume is the outcome of a course of instruction 
given to the nurses at the Crouse-Irving Hospital. 

It is not intended for medical students or practitioners, but 
is written to serve as a practical guide for nurses who lack 
special training in the management of ophthalmic cases. 

Care has been taken to avoid scientific terms and expres- 
sions, and to present the subject in a complete but condensed 
form and in a manner that may be readily understood by all. 
It is in no way a treatise on diseases of the eye, but has to do 
only with those facts which are . necessary for a nurse to know 
if she expects to render intelligent assistance to the oculist 
and efficient care to the patient. 

A unique and valuable feature is the catechism in the latter 
part of the book. Here the questions asked cover everything 
of any importance pertaining to the subject. After a thorough 
perusal of the preceding chapters, and perhaps a review of the 
same, the nurse is to write down on paper the answer to each 
question, numbering it accordingly. When all of these questions 
have been answered in this way, she may refer to the page 
and line indicated by the numbers after each question to see 
how correctly she has answered it. She may mark the ques- 
tions which were not satisfactorily answered, again review the 
subject-matter pertaining thereto, and, after the lapse of a few 
days, repeat the examining process as described above. In 
this way any intelligent nurse will, in a remarkably short 



12 PREFACE 

time, acquire a degree of proficiency which will enable her to 
meet any requirement of the ordinary case. 

The author trusts that his effort may prove a useful assist- 
ant in the formation of correct ideas regarding the anatomy, 
physiology, and hygiene of the eye, and begs the kind indul- 
gence of the readers for any manifest shortcomings. 

G. Griffin Lewis. 
Syracuse, N. Y., 
April, 1920. 



CONTENTS 



CHAPTER I PAOE 

The Requisites of a Successful Nurse 17 

The Relation of the Nurse to the Physician 17 

CHAPTER II 

Anatomy of the Eye 22 

Orbits 22 

Eyeball 23 

Cornea 23 

Sclera 23 

Iris 24 

Ciliary Body 25 

Choroid 25 

Retina 25 

Aqueous 26 

Crystalline Lens 27 

Vitreous 28 

Pupil 28 

Muscles 29 

Eyebrows 31 

Eyelids 31 

Conjunctiva 32 

Lashes 32 

Lacrimal Apparatus 33 

CHAPTER III 

Physiology of the Eye 35 

Likeness of Eye to the Camera 35 

Normal Refraction 35 

Near-sighted Eye 35 

Far-sighted Eye 35 

Accommodation 37 

. Old-sight 39 

Astigmatism 40 

13 



14 



Hygiene of the Eye. 



CONTENTS 
CHAPTER IV 



PAGE 

43 



CHAPTER V 

Practical Ophthalmic Nursing 47 

Eye Drops 47 

Poisonous Solutions 52 

Atropism 52 

Eversion of Lids 

Compresses 54 

Ointments 58 

Powders 59 

Poultices 59 

Massage 59 

Electricity 61 

Leeching 61 

Counterirritants 65 

Mercurial Inunction 64 

Sweating 65 

Rest 65 

Contagious Eye Diseases 65 

Ophthalmia Neonatorum 68 

CHAPTER VI 

Ante-operative Care 71 



CHAPTER VII 
In the Operating Room 



79 



CHAPTER VIII 



Postoperative Nursing. 



N4 



CHAPTER IX 

Ophthalmic Materia Medica 90 

Local Anesthetics 90 

Analgesics 90 

Antiseptics 90 

Astringents 91 

Caustics 91 

Counterirritants 92 

Emollients 92 



CONTENTS 15 

PAGE 

Irritants 92 

Lymphagogues 93 

Mydriatics 93 

Myotics 93 

Refrigerants 93 

Rubefacients 93 

Staining Agents 93 

Stimulants 94 

Styptics 94 

Vasoconstrictors 94 

Vasodilators 94 

CHAPTER X 

Consideration of Ophthalmic Remedies 95 

Synopsis of Preceding Text Matter 121 

Ophthalmic Instruments , 124 

Ophthalmic Operations 132 

Glossary 137 

Catechism 147 

Index 167 



THE OPHTHALMIC NURSE 



CHAPTER I 

THE REQUISITES OF A SUCCESSFUL NURSE 

It would not only be difficult but tiresome to depict all 
the attributes that might enter into the composite picture 
of a model nurse, so we will but briefly refer to some of the 
more essential ones. 

The ideal nurse should have something more than the 
mere technical skill in doing things which are required by 
the sick. First of all, she should be a good woman, with 
sound health and the right personal qualifications, both 
mental and physical. She should have a love for work, 
sacrifice, and humanity with all that this quality implies. 
Her value will depend much more upon her personal qual- 
ities, her conduct, and experience than upon her knowledge 
of anatomy and materia medica. 

The demand for her service will also depend largely upon 

her personal appearance, attractive manner, and cheerful 

spirit. She should be properly attired in correct uniform 

with no rustling of silk skirts, scent of perfumery, or glitter 

of jewelry. 

2 I7 



1 8 THE OPHTHALMIC NURSE 

She must be cheerful and optimistic. This is often dif- 
ficult, especially after long hours of sleepless vigilance and 
lack of proper exercise, when the patient is feverish and fret- 
ful, and the family anxious and may be even distrustful and 
unreasonable, but just imagine the effect upon a nervous, 
impressionable patient of a gloomy and grouchy nurse. 

Optimism on her countenance, hope in her heart, sym- 
pathy in her touch, and kindness in her speech are of more 




Fig. 1. — The uniformed nurse. 

value to the patient's eyes than is the ability to take the 
temperature or give a hypodermic injection. 

She should be charitable, and she will get from the patient 
and his family a sincere gratitude which will go far toward 
making life worth while. She should not go forth as a mere 
wage earner, but as a dispenser of a greater bounty, as a 
devoted helper in the great field of human need. In other 
words, she should show how much she can put into her pro- 



THE REQUISITES OF A SUCCESSFUL NURSE 19 

fession, not how much she can get out of it. I have little 
respect for the nurse who will consider her own comfort para- 
mount to that of her patient. 

The capable nurse is practical, observing, and resourceful, 
traits which are best acquired by being pressed into service 
under superior guidance, coming into direct contact with 
the case, and watching its different phases until able to at- 
tend to the same upon her own responsibility. To do this 
she must study the patient clinically, observe his mental and 
physical changes, the action upon him of medicines and 
treatments of any kind, the benefits of diet, the changes of 
pulse, respiration, etc.; in fact, she must have every detail 
of her work under close actual observation. 

Accuracy is also an essential element of a nurse's educa- 
tion. The attending physician always appreciates accurate 
data relative to the patient's personal and family history, 
occupation, habits, mode of living, diseases of childhood and 
previous eye affections, as well as to the pulse, temperature, 
respiration, and urinalysis, as a knowledge of all of these con- 
ditions is of inestimable value to him and enables him to 
oversee the progress of the case in all its details. 

Presence of mind in the affairs of life is of benefit to all, 
but particularly is it valuable in the professions that have to 
do with the lives of individuals, and the nurse who can think 
and act quickly and wisely has a most valuable asset. 

Nurses are likely to see many family skeletons drawn from 
their closets. Matters of mind as well as those of the body, 
matters that effect the honor and peace as well as those that 



1 



20 THE OPHTHALMIC NURSE 

effect the health of individuals and families are laid bare to 
the nurse; therefore, she should guard the sanctity of the 
home and see to it that no one's character or reputation suffer 
because of any knowledge that has come to her in this way. 

While persuing her course in the training-school the pupil 
nurse is under the direct supervision and guidance of those 
whose friendly responsibility is to aid and instruct her, but 
after graduation she loses this friendly assistance and be- 
comes dependent upon her own capabilities. It is then that 
she must see at a glance the situation, and must either do or 
neglect to do the thing that may mean life or death to her 
patient. There are many attributes that are essential to 
her success that she must gather from experience and train- 
ing after she goes out from her Alma Mater; therefore, she 
should best inform herself more exactly regarding the many 
facts that suggest themselves as she goes along by means of 
suitable reading and intelligent interrogation of those more 
proficient in the art. 

In family nursing the surroundings are entirely different 
from those she has been accustomed to, and so it frequently 
happens that many nurses who did excellent work in the 
hospital utterly fail in family practice. She should remem- 
ber that the family routine should not be disturbed except 
when absolutely necessary; she should avoid loud or whis- 
pered conversation, but should speak in a low, quiet tone; 
she should never sit on the edge of a bed; she should become 
acquainted with the location of everything which she may 
need; she should leave nothing in the patient's sight which 



THE REQUISITES OF A SUCCESSFUL NURSE 21 

would continually impress him with thoughts of sickness, 
such, for instance, as bottles, surgical dressings, etc. 

While nursing in families with plenty of servants she is 
entitled to liberal service herself, but when nursing in fam- 
ilies of limited means she should be resourceful and helpful. 
She should teach all the members of the family the laws of 
health pertaining to fresh air, cleanliness, light, exercise, etc. 

THE RELATION OF THE NURSE TO THE PHYSICIAN 

The relationship of the nurse to the physician has no 
special code of ethics except that of the Golden Rule. The 
nurse should not forget that she is the employee of the doc- 
tor, though paid by the patient, and that she has no authority 
in the case further than that relegated to her by the doctor, 
who in recommending her assumes a responsibility in her 
skill, her behavior, and, I might add, her moral character; 
therefore, she should do her work promptly, quietly, and 
faithfully in accordance with his instructions, thereby add- 
ing materially to his comfort and success. 

The nurse should have no favorite doctor, or ever allow 
a patient to know that she values the skill of one physician 
above that of another. She should not think that because 
two surgeons manage their cases differently that one is 
wrong; in fact, she should always uphold the medical at- 
tendant and neither say nor do anything to impair the con- 
fidence reposed in him by the patient. A shrug of the 
shoulder or an elevated eyebrow may make an irremediably 
unfavorable impression upon the patient or his friends. 



CHAPTER II 



ANATOMY OF THE EYE 



A clear understanding of the gross anatomy and phys- 
iology of the eye is quite necessary for one to have who ex- 
pects to intelligently care for that organ when diseased, in- 
jured, or operated upon. 

Optio Foramen J 

few \ 




Fig. 2.— The orbit. (Manhattan Hospital.) 

5 First, we will consider the anatomy, beginning with that 
of the orbits, the bony, cone-shaped cavities in which the 
eyeballs are situated, and the walls of which are formed by 
the union of seven different bones, viz.: the frontal, the 
superior maxillary, the malar, the sphenoid, the ethmoid, 

10 the lacrimal, and the palate. 



ANATOMY OF THE EYE 23 

At the apex of the orbit is an opening called the optic 
foramen, through which passes the optic nerve and the oph- 
thalmic artery. The apex is also filled with an adipose 
tissue called the orbital fat, upon which the back part of the 
eyeball rests and which acts as a cushion in protecting it 5 
from blows, etc. 

The eyeball (see frontispiece) is about 1 inch in diameter 
and is composed of three tunics or coats. The anterior one- 
fifth of the first coat is composed of the cornea, and the pos- 
terior four-fifths, of the sclera. The cornea projects from the 10 
general contour of the eyeball like a watch crystal from the 
face of the watch. It is thicker at its edge than at its center. 
Being non-vascular it receives its nutrition from the an- 
terior ciliary vessels, which form a network of loops around 
the margin of the cornea. Minute nerve branches pass 15 
freely to the epithelial layer, which act as a protection to 
that membrane by giving it extreme sensibility to all ex- 
ternal injurious influences. 

Injuries and inflammations of the cornea are fraught with 
much danger, and if its integrity is impaired correct vision 20 
will be impossible. 

The sclera is a firm white fibrous membrane varying in 
different parts from § to 1 mm. in thickness. It maintains 
the shape of the eyeball and to it are attached the muscles 
which move it. Posteriorly and about 10 degrees to the 25 
nasal side of the center the sclera has an opening, about 2 
mm. in diameter, for the entrance of the optic nerve. It is 
also perforated at various places by veins (venae vorticosae) 



24 



THE OPHTHALMIC NURSE 



and by the posterior and anterior ciliary arteries and 
nerves. 

The second or middle coat of the eyeball is composed of 
the iris, the ciliary body, and the choroid, all three of which 
are sometimes classified under the general name of "uveal 
tract." The first of these three, the iris, gives color to the 
eye and imparts expression to the face. It derives its name 




Fig. 3. — The optic nerve. 



from its varied hue, black, brown, gray or blue, according 
to the amount of pigment it contains. In that of the albino 
10 there is no pigment, and the blood-vessels, shining through 
its walls, give the eye a pink color. Those of you who have 
never seen an albino have no doubt noticed the pink eyes 
of a white rabbit. 
All eyes are blue at birth, the commencement of perma- 



ANATOMY OF THE EYE 25 

nent coloration taking place about the sixth week. Dark 
colored eyes are usually stronger than light ones, inasmuch 
as they are better protected against excessive light. 

The iris divides the aqueous humor into two parts, known 
as the anterior and posterior chambers, which communicate 5 
with each other through the pupil. The iris is composed of 
two sets of muscular fibers, the circular, which cause con- 
traction of the pupil, and the radiating, which cause dila- 
tion of the pupil. 

The ciliary body is a muscular apparatus composed of 10 
processes, about seventy in number, which are called the 
ciliary processes. They surround the iris like radii around 
the sun, and as they pass forward they become thicker and 
more muscular in nature until they merge into what is 
known as the ciliary muscle, a most important tissue both 15 
from the physiologic and pathologic standpoint, as you will 
see later. 

The choroid is made up of five layers and is composed 
chiefly of blood-vessels. Its function, by virtue of its great 
vascularity, is to nourish the retina, vitreous, and lens, to 20 
furnish the visual purple, and, by its pigmentation, to make 
the interior of the eye a dark chamber or camera. 

The third or inner coat of the eyeball is composed of the 
retina, a very delicate, transparent membrane which is a 
continuance of the brain substance into the eyeball, and 25 
which, like the sensitive plate of the photographer's camera, 
receives the impression of external objects. The retina is 
held in contact with the choroid by the vitreous humor. The 



26 



THE OPHTHALMIC NURSE 



optic nerve-fibers spread out in all directions from the disk 
and pass through the layers of the retina. The part of the 
retina corresponding to the optic nerve entrance is known 
as the disk, nerve head, or papilla. 

The retina is not equally sensitive in all of its parts to 
visual impressions. A small area called the "fovea," which 
is situated directly in the axis of vision, is the most sensitive 
portion, and, in order to secure a clear and accurate view of 




Fig. 4. — The choroid. 



any object it is necessary to focus rays from that object 
10 simultaneously upon the "fovea" of each eye. When this 
is not accomplished double vision results. That portion 
immediately around the fovea is called the "macula," and it 
is the most vascular part of the retina, while the fovea itself 
has no vessels. 
15 Within the eye are three humors: first, the aqueous, 
about 10 drops in all, which occupies the space between the 



ANATOMY OF THE EYE 27 

cornea and the lens. It is a clear, transparent, salty fluid, 
and, as its name implies, is of a watery consistency. It is 
secreted by the vessels of the iris and ciliary body, and, as 
its function is to maintain the proper tension of the eye and 
allow free movements of the iris, it is fortunate that when it 5 
is partially or wholly lost by puncture of the cornea it is 
rapidly reproduced. 

The second humor is the crystalline lens, a semisolid, 
double convex body situated just back of the aqueous. It 




Fig. 5. — The fovea centralis. 

is enclosed in a transparent elastic capsule which is sus- 10 
pended at all portions of its circumference by a circular liga- 
ment, the ciliary ligament, which, in its turn, is attached to 
the ciliary muscle, and, having no blood-vessels, is depend- 
ent for its nutrition upon the lymph thrown out from the 
blood-vessels of the iris and ciliary body. The lens is cap- 15 
able by its elasticity and by contraction and relaxation of 
the ciliary 7 muscle of becoming more or less convex, thus 



28 THE OPHTHALMIC NURSE 

changing the focus of the eye as it looks from one object to 
another. 

The third humor is the vitreous, a large globular body of 
the consistency of jelly, which is enclosed in a delicate en- 
velope called the hyaline membrane. It occupies about 
two- thirds of the interior of the eyeball, and is the chief 
factor in maintaining its form. It also has no blood-vessels 
and gets its nutrition from those of the adjacent structures. 




Fig. 6.— The crystalline lens. 



The pupil is the opening in the center of the iris, which is 
10 enlarged or contracted by the muscles of the iris. In the 
dark it dilates in order to enhance intra-ocular illumination, 
and in the light it contracts to prevent too much light from 
striking the delicate retina. When the iris is at rest the 
pupil has an average diameter of about i inch. Variations, 
15 however, are met with in different persons and in the same 
person at different times, thus people of a sanguine tem- 



ANATOMY OF THE EYE 29 

perament generally have small pupils, while those of sluggish 
habits generally have large pupils. 

It varies in size at different ages, growing smaller as age 
advances. It is larger in near-sightedness than it is in far- 
sightedness. Local affections within the eye, as well as 
diseased conditions elsewhere in the body, affect its size, 
as do also various drugs. 

When consciousness is lost, as under the influence of an 
anesthetic, the pupil becomes dilated and does not respond 




Fig. 7. — Pupillometer for measuring size of pupil. 

to light. When the eye looks at objects nearby the pupil 10 
is smaller than when looking at distant objects. In the 
healthy and strong it is smaller and more active than it is 
in those who are depressed and exhausted by long illness. 

The Muscles. — Each eye has seven muscles which per- 
form all the movements necessary in the function of vision, 15 
and it is only when the adjustment of these muscles is per- 
fect that accurate binocular vision can be maintained. 
Every movement of the eye requires an instantaneous con- 



3o 



THE OPHTHALMIC NURSE 



traction or relaxation of one or more of these muscles, thus 
it is evident that sight is not a passive function, but an 
active one, and, although we see apparently without any 
effort, every movement costs its adequate amount of vital 
energy, and especially in defective eyes does the effort on the 
part of the ciliary and external ocular muscles to maintain 
accurate binocular vision spur the oversensitive nerve- 
centers to extraordinary exertion. 



rectLipC 




gpi rect. 3up 

3EU 1 rect>. ex&. 

./ec6. inCt. 

obi. sup. 



Fig. 8. — The extra-ocular muscles. (Landolt.) 



Of the external ocular muscles there are four recti and 
10 two obliques. The internal rectus arises from the inner 
side of the optic foramen, is attached to the sclerotic coat 
on the nasal side of the eyeball, and serves to turn the eye 
toward the nose. The external rectus arises from the outer 
margin of the optic foramen, is attached to the sclera on the 
15 outer surface of the eyeball, and serves to turn it out. The 
inferior rectus arises from the inferior surface of the optic 



ANATOMY OF THE EYE 31 

foramen, is attached to the sclera on the under side of the 
eyeball, and serves to turn it down. The superior rectus 
arises from the upper margin of the optic foramen, is at- 
tached to the sclera on the upper surface of the eyeball, and 
serves to turn it up. The superior oblique arises near the 5 
optic foramen, passes forward through a pulley on the upper 
and inner side of the orbit, and then deflects back beneath 
the superior rectus muscle to become attached to the pos- 
terior outer surface of the eyeball, and it serves to rotate it 
outward. The inferior oblique arises from near the inner 10 
anterior angle of the orbit, passes outward and backward 
beneath the eyeball, and is attached to the sclerotic at the 
posterior outer surface of the ball, and serves to rotate it 
inward. 

Appendages of the Eye. — The eyebrows impart expression 15 
and beauty to the face and protect the eyes from the per- 
spiration as it trickles down the forehead. 

The eyelids are two movable curtains which, when closed, 
cover the front of the orbit, and serve as a protection to the 
eyeball. Each lid contains a thin plate of dense fibrous 20 
tissue which very much resembles cartilage and serves to 
maintain the shape of the lid. In sleep the muscles of the 
upper lids relax and allow them to fall down over the globes, 
thus protecting them from the light and air. The inner side 
of the lid is lined with a thin colorless membrane extending 25 
from the edge of the lid to its extreme inner surface, whence 
it is reflected on to the eyeball, being attached around the 
circumference of the cornea. The portion lining the eyelids 



32 



THE OPHTHALMIC NURSE 



is called the palpebral conjunctiva, while that on the eyeball 
is called the bulbar conjunctiva, the epithelial or outer layer 
of which is transparent and extends entirely across the cor- 
nea, forming the anterior or epithelial layer of that struc- 
ture. The conjunctiva is so well supplied with nerve fila- 
ments that if any foreign body gets into the eye it acts 
reflexly upon the lacrimal gland and causes an increased flow 
of tears which usually wash the foreign substance out. The 
conjunctival blood-vessels are invisible in health, but when 




Fig. 9. — The conjunctiva. 

io the eye becomes inflamed the vessels become enlarged and 
hide from view the shining white sclera beneath. 

On the edge of each lid is a row of cilia, the so-called lashes. 
The slightest touch of any object to these cilia will cause an 
instant and involuntary closure of the lids, thus frequently 

15 preventing substances from entering the eye. 

Lying just to the inner side of the cilia on each lid is a row 
of little glands called the Meibomian glands, which secrete 
an oily fluid, the principal function of which seems to be to 
prevent the overflow of tears. 



PHYSIOLOGY OF THE EYE 37 

dation, as it is sometimes called. A contraction of the latter 
muscle relaxes the lens capsule and the lens substance, 
through its elasticity, assumes a greater convexity, and 
thereby becomes stronger in its refractive power so that it 
is enabled to focus rays upon the retina. In other words, 5 
the accommodation is the power the eye possesses of adapt- 
ing itself to see objects at different distances distinctly. In 
looking at distant objects one relaxes his accommodation; 




Fig. 16. — Illustrating the act of accommodation. 

in looking at near objects he exerts his accommodation, and 
the rapidity with which the lens successively focuses dif- 10 
ferent objects at varying distances is one of the marvels of 
nature. It can, therefore, be readily seen how the normal 
or the near-sighted eye, in receiving parallel rays or in look- 
ing at distant objects, will require no action on the part of 
the muscle of accommodation, but in the far-sighted eye 15 
this muscle is called into almost constant action. Rays of 



38 



THE OPHTHALMIC NURSE 



light from any object within 18 or 20 feet are more or less 
divergent, therefore the normal eye is only required to ac- 
commodate when looking at objects within that distance, 
while the far-sighted eye, in order to see distinctly, must 
5 accommodate for all distance. These refractive errors can 




Fig. 17. — Myopic eye with concave lens. 

be readily overcome by the adjustment of proper glasses. 
The kind and strength of glass to be used depends upon the 
kind and amount of error present; thus, in a near-sighted 
eye, where the rays are brought to a focus before they reach 




Fig. 18. — Hyperopic eye with convex lens. 

io the retina, a concave glass is used to lengthen their focal 
distance. For the far-sighted eye, where the rays strike 
the retina before they are brought to a focus, a convex lens 
is used to shorten this focal distance, and the strength of the 
lens necessary in either case depends upon the amount of 



PHYSIOLOGY OF THE EYE 



39 



shortening or lengthening required to bring the focus upon 
the retina. 

In the early years of life the ciliary muscle, ciliary liga- 
ment, lenticular capsule, and crystalline lens respond with 
alacrity to the slightest need or wish of the individual, but, 
as the meridian of life is passed, the ciliary muscle and ciliary 
ligament become less active, the capsule of the lens becomes 
less elastic, and the lens itself becomes harder, more com- 
pact, and less capable of changing its shape to one of greater 



Anterior detachment of ^Vitreous. 




posterior deio-chmentoP ft &r e ous 
DisplacextopZic Nerve papilla. 
Broadened inLermernbr<xiioos 



Fig. 19. — Detachment of the retina. 



convexity when small and near objects are brought into 10 
view, consequently one is compelled to hold the book further 
away in order to see more distinctly. This condition, which 
is familiarly known as old-sight (presbyopia) , comes on very 
gradually and the use of suitable glasses should not be ne- 
glected after the early symptoms of old-sight are noticed. 15 
The eye, which is normal in youth, will begin to show old- 
sight at forty-two to forty-five years of age, and frequently 
ill health, nervous debility, or constant use of the vision 
for fine work will hasten it. 



40 THE OPHTHALMIC NURSE 

Near-sightedness, as a rule, causes very little eye-strain 
and therefore people with a little or a moderate degree of 
near-sightedness are apt to go without correcting lenses, 
but near-sightedness left uncorrected is apt to set up a dis- 




Fig. 20. — Simple hyperopia astigmatism. (Fox.) 

ease in the interior of the eyeball which is dangerous and 
sometimes leads to total blindness. The eyeball being 
elongated unduly, the vitreous is no longer adequate to fill 
the space it occupies under normal conditions, consequently 




Fig. 21. — Simple myopic astigmatism. (Fox.) 

the retina, lacking the support of the vitreous, floats loose 
10 from its attachments. 

A most peculiar and disturbing defect of the eye is the 
condition known as astigmatism, where there is an inability 



ANATOMY OF THE EYE 



33 



The lacrimal apparatus consists of the lacrimal gland, the 
lacrimal punctae, the lacrimal sac, and the lacrimal duct. 




Fig. 10. — The Meibomian glands. 

The gland is a small almond-shaped body lying in a fossa at 
the upper outer angle of the orbit, just under the supra- 




Fig. 11. — The lacrimal apparatus. 

orbital ridge. It secretes tears through a dozen or more 5 
small ducts, which flow over the eyeball to the punctae situ- 



34 THE OPHTHALMIC NURSE 

kted in the inner angle of the eye, one on each lid. Through 
the punctae the tears run into the lacrimal sac, and from 
there through the lacrimal duct into the nose. The lacrimal 
secretion is a salty fluid which flows constantly, thus keeping 
the eye moist and enabling the lids to glide easily upon the 
eyeball. When one cries this secretion forms more rapidly 
than the punctae will accommodate, consequently it flows 
over the lower lids on to the cheeks. 






CHAPTER HI 

PHYSIOLOGY OF THE EYE 

Rays of light from any point pass through the cornea, the 
aqueous humor, and the pupil, to be focused by the crystal- 
line lens through the vitreous body upon the retina. 




Fig. 12. — Emmetropic eye. 

The eye which is of normal refraction (emmetropia) is 
one the lens of which, when perfectly at rest, will bring 5 
parallel rays of light to a focus exactly upon the retina. 




Fig. 13. — Myopic eye. 

The near-sighted eye (myopia) is one the lens of which, 
when perfectly at rest, will bring parallel rays to a focus before 
they strike the retina. In the far-sighted eye (hyperopia), 

35 



36 



THE OPHTHALMIC NURSE 



when the lens is perfectly at rest, parallel rays will strike the 
retina before they are brought to a focus. These conditions 
can be readily understood by those who may be familiar with 




Fig. 14. — Hyperopic eye. 

the workings of a camera and realize the necessity of prop- 

5 erly focusing the rays upon the sensitive plate in order to get 

a clear, distinct picture. In the camera the focusing is 




Fig. 15. — Showing length of eyeball in different refractive conditions. 

done by moving the lens toward and from the sensitive 

plate, while in the eye the focusing is done by a change in 

the focal distance of the lens, brought about by its elasticity 

io and regulated by the ciliary muscle or muscle of accommo- 



HYGIENE OF THE EYE 45 

are pretty sure to become more so unless the defect is cor- 
rected before school life is begun and proper care taken of 
them during that period. Near-sightedness may be pro- 
duced by improper or insufficient light, poor print, and the 
stooping posture while reading or studying. It is astound- 5 
ing how many children develop progressive near-sightedness 
from this latter cause alone. With the head bent forward 
and the eyes looking almost straight down instead of ahead, 
too much blood is forced into the globes and a congestive 
condition ensues which is prone to cause near-sightedness. 10 

Half an hour at a time is as long as a child of six or seven 
should devote his mind to any object, and he should then 
be allowed to rest. It is also wrong to require any mental 
work of a child on an empty stomach or immediately after a 
meal. The act of digestion requires a large supply of blood, 15 
and so long as that act is in progress, the rest of the system, 
the brain in particular, must be comparatively bloodless, 
and if it be brought into play it diverts a certain quantity of 
blood from its proper destination and interferes with the due 
assimilation of the food. 20 

The books that are placed in the hands of young children 
should not be large and heavy, the paper should be white, 
but not shiny, the letters large, well formed and clearly 
printed, the spaces between the letters and between the 
lines relatively wide, and the lines not too long. 25 

If the print is small or the light is dim, the book is neces- 
sarily brought within a few inches of the eye and the strain 
of that organ is very great. 



46 THE OPHTHALMIC NURSE 

While we are considering ocular hygiene, there is one point 
pertaining to your every-day work which I wish to empha- 
size in particular, and that is, never allow a patient to read 
while lying down or while convalescing from disease. At 
such a time, when their ocular muscles are below par, the 
same as in their general muscular system, refractive and 
muscular anomalies of the eye are very easily developed. 



CHAPTER V 

PRACTICAL OPHTHALMIC NURSING 

Eye Drops. — It would seem to be an easy matter to apply 
drops to an eye, and yet there is a right and a wrong way to 
proceed. There are various methods employed, depend- 
ing upon the purpose for which the drops are intended. If 
a boric acid or a bichlorid of mercury solution is used for 




Fig. 25. — Instilling cleansing solution. 

cleansing, the head should be inclined so that the inner 
angle of the eye may be filled with the solution, and the 
patient is instructed to roll his eye in various directions so 
as to bring all parts in contact with it. The eye is then 
closed and the solution is absorbed with a pledget of cotton. 10 

47 



4 8 



THE OPHTHALMIC NURSE 



By having the patient look down and then pulling down the 
lower lid, a cul-de-sac is formed. This can be filled with a 
solution which then lies in contact with the whole anterior 
part of the eyeball. If it is intended that the solution 
should flow over the cornea the upper lid should be drawn 
up and away from the eye, while the patient with his head 
thrown back, looks downward, the cornea being exposed so 
that the drops may be made to fall directly upon it. 





^L/fj\2. 






V^ *ftjts$ J 




^jfr~V \~T/ 


oft 


(r V 


\ 



Fig. 26. — Instilling poisonous solution. 

When poisonous medicines are used, such as atropin or co- 
10 cain, the head should be inclined so that the solution will 
run away from the tear duct; the patient is requested to 
look up while the lower lid is pulled down and the required 
number of drops are instilled near the outer canthus. One 
or two drops at the most is quite sufficient, as anything in 
15 excess of that is wasted, because, as the lid is released, the 
excess is either forced down the tear duct or over the cheek. 
These precautions are necessary as the poisonous solutions 



PHYSIOLOGY OF THE EYE 



41 



of that organ to see vertical and horizontal lines equally well. 
This curious defect is due to an uneven curvature of the 
cornea. Instead of being spheric, it is in shape more like 




Fig. 22. — Compound hyperopic astigmatism. (Fox.) 




Fig. 23. — Compound myopic astigmatism. (Fox.) 




Fig. 24. — Mixed astigmatism. (Fox.) 

the bowl of a spoon, thus giving the eye two foci instead of 
one focus. Astigmatism usually dates from birth, although 5 
in some eyes the muscle of accommodation is able, up to a 



42 THE OPHTHALMIC NURSE 

certain age, to overcome it, and such eyes may not require 
glasses until the muscle becomes weakened with age or 
abuse. There are six kinds of astigmatism: first, simple 
far-sighted astigmatism, in which one meridian of the 

5 cornea is of normal curvature, while the one at right 
angles to it is far-sighted (less curved); second, simple 
near-sighted astigmatism, in which one meridian is normal 
and the other is near-sighted (more curved); third, com- 
pound far-sighted astigmatism, in which both meridians are 

10 far-sighted, but one more so than the other; fourth, com- 
pound near-sighted astigmatism, in which both meridians 
are near-sighted, but one more so than the other; fifth, 
mixed astigmatism, in which one meridian is near-sighted and 
the other is far-sighted, and sixth, irregular astigmatism, in 

15 which the corneal surface is unevenly curved. This latter 
form is not correctable by glasses. 



CHAPTER IV 
HYGIENE OF THE EYE 

It is one of the duties of the nurse to help educate the 
public in matters of ocular hygiene. The proper care of the 
eye during infancy is of the utmost importance as regards use- 
ful vision in after years. Proper cleansing of the maternal 
passages before the birth of the child and of the child's face 5 
and eyes just after birth with antiseptic solutions should not 
be neglected. An excellent and perfectly safe plan to fol- 
low is to first cleanse the outside of the eye with a lukewarm 
solution of boric acid (gr. 15 ad. oz. j), then drop in a few 
drops of a 15 or 20 per cent, solution of argyrol, several 10 
minutes later cleansing them again with the boric acid. 
This procedure should be repeated twice a day for two or 
three days. If, in spite of this precaution, the eyes should 
become red and inflamed, a physician should be consulted 
at once, as the child, in all probability, has ophthalmia 15 
neonatorum, which disease is responsible for fully two- 
thirds of the inmates of our blind institutions. 

Infants should never be exposed, even in sleep, to the 
glare of strong light, artificial or natural, and this is par- 
ticularly imperative when the child is taken out in a car- 20 
riage with its face looking up toward the heavens. The 
eyes should then be protected by a parasol lined with some 

43 



44 THE OPHTHALMIC NURSE 

dark material which will not reflect the sun's rays upon the 
face. At other times a projecting bonnet or hat will pro- 
tect them from bright sunshine, and, as soon as artificial 
light becomes necessary, the child should be put to bed. 

5 Never keep a bright light in a room with a sleeping in- 
fant, as the sudden exposure of the sensitive retina to the 
light upon awakening may do irreparable harm. No 
doubt we would all be amazed and horrified if we were able 
to estimate accurately the large percentage of unfortunates 

10 with defective vision who were made so by the carelessness 
of incompetent nurses in exposing the eyes of the newborn 
to too bright a light. 

The attention of an infant should not be directed to ob- 
jects held close to its face, as the development of near-sigh t- 

15 edness or "crossed eyes" may be thereby encouraged. 

During the period of teething eye trouble, such as con- 
junctivitis and phlyctenule, frequently occurs by reflex 
irritation through the dental nerves. Convulsions at this 
time are a common cause of cataract. 

20 The use of the eyes for close work at a tender age, when 
the tissues of that organ are soft and yielding, is exceedingly 
hazardous, and for this reason it is not prudent for children 
to enter school before eight or nine years of age unless their 
general health is sufficient to endure the strain. Further- 

25 more, every child should undergo a thorough examination 
of the eyes and have all necessary refractive corrections 
made before entering upon his school duties, for during the 
critical period of growth eyes which are already defective 



PRACTICAL OPHTHALMIC NURSING 



49 



may pass down the tear duct into the nose and throat, pro- 
ducing systemic effects. 

It frequently happens that a patient is ordered to use both 
eye drops and lotions. When this is so, it is needless to say 
that the lotions must not immediately succeed the use of the 
drops, otherwise there would be a risk of destroying their 
efficacy. There should be at least an interval of half an 
hour between the two. 




Fig. 27. — Instilling drops in a child's eye. 



Sometimes considerable difficulty is experienced in instill- 
ing drops into the eyes of children. If requested to open the 10 
mouth, the closed lids will be more easily managed. With 
very small children or babies an assistant is required to hold 
the child's arms and body, while, with its head in your lap 
between your knees, the lids can be easily manipulated. The 
best way, however, in the majority of cases, is to have the 15 
child lie flat on its back on the bed, and, while the eyes are 
closed, the required number of drops are placed into the 
inner angle of the eye so that the fluid will run into it when 
4 



50 



THE OPHTHALMIC NURSE 



opened. Should the child be too young or refuse to open the 
eye, the nurse should gently separate the lids with her 
fingers. Never use violence, for, if the cornea is ulcerated, 
undue pressure may rupture the eyeball and do irreparable 
harm. The bottles which contain the medicine may be 
kept in a warm place or the pipet may be dipped in warm 
water for a few seconds after filling. 




Fig. 28. — Holding the pipet. Improper way. (Theobald.) 




Fig. 29. — Holding the pipet. Proper way. (Theobald.) 

The pipet should be sterile and great care should be taken 

in holding it. It should not at any time, when filled, be 

io turned upside down so that the solution runs into the rubber 

part, as in that way, especially if the pipet is a new one, 

many small particles of rubber may be introduced into the 



PRACTICAL OPHTHALMIC NURSING 51 

eye. It should not be allowed to come in contact with the 
patient's lid or eyeball, as it would be possible in that way to 
transfer infectious material to the solution bottle or from 
one eye to another. Patients frequently "start" when drops 
are instilled, theiefore it is well to hold the dropper far 5 
enough from the eye so that no harm can be done at such a 
time. 

In contagious diseases, such as gonorrheal conjunctivitis, a 
special dropper should be set apart for each case. Another 
very important point to remember is that a dropper which 10 
has been used for a mydriatic, such as atropin, should not 




Fig. 30. — The bulb syringe. 

be used for the instillation of other medicines, as neglect of 
this precaution may result in a dilation of the pupil and a 
blurring of the vision which will cause the patient much 
needless inconvenience. 15 

In some cases where there is a tenacious discharge of 
mucus or pus, a small rubber bulb syringe may be found 
more serviceable than the pipet, but in using it great care 
should be taken not to hold it directly against the cornea or 
to use too much force. In some cases the so-called eye-cup 20 
or eye-bath is desirable, especially where the patient prefers 
to apply the solution himself. After filling it about a third 



52 THE OPHTHALMIC NURSE 

full of the solution the head is thrown forward, the cup ap- 
plied firmly over the closed lids, then the head is thrown 
back and the eye opened and closed several times, after which 
the head is once more thrown forward and the cup removed. 

5 Camel's-hair brushes should never be used to apply liquids 
to the eye, as they are difficult to keep clean and the danger 
of infection being transmitted is too great. 

Poisonous Solutions. — Children and infants upon whom 
strong solutions or moderately strong solutions of poisonous 

10 drugs are being used should be carefully watched. Some of 




Fig. 31. — The eye-cup. 

the fluid may pass through the lacrimal passages into the 
nose, and thence down the throat into the stomach, and set 
up grave symptoms, the cause of which may be entirely over- 
looked by anyone unaccustomed to recognize them. This 

15 is especially likely to happen with atropin. 

Atropism. — If the infant becomes restless and feverish, ap- 
pears thirsty, and has a dry tongue, be suspicious that it is 
becoming atropinized. If you continue the drops a red rash 
will probably appear, and this is sometimes mistaken for 

20 scarlet fever. In adults there is less fear of severe con- 
stitutional symptoms. They generally notice the dryness 



PRACTICAL OPHTHALMIC NURSING 



53 



of the throat which it produces and complain of it suf- 
ficiently early to prevent a continuance of its use. 

Sometimes atropin produces an inflammation of the lids 
which may even extend more or less over the face, resembling, 
in many respects, erysipelas. 

When applications are to be made directly to the lids it 
becomes necessary to evert them. This little feat is quite 
difficult in some cases where the lids are swollen and the 




Fig. 32. — Inverting the lower lid. 



lashes are nearly or all gone, and yet it is something that 
every 7 nurse ought to know how to do. To evert the lower 10 
lid is simple enough. All you have to do is to stand behind 
the patient, draw down his lower lid, and have him look up. 
To evert the upper lid, stand behind the patient and have 
him look down, at the same time seizing the lashes of the 
upper lid, drawing it downward and outward, depressing the 15 
cartilage with the finger or pencil. During the maneuver 
care should be taken not to exert pressure upon the eyeball. 



54 



THE OPHTHALMIC NURSE 



Compresses. — Either hot or cold compresses are generally 
used some time during the course of most eye diseases, and 




Fig. 33. — Inverting upper lid with fingers. First step. 

the one which is the more agreeable to the patient is, as a 
rule, the one which does the most good. This rule cannot, 




Fig. 34. — Inverting upper lid with fingers. Second step. 

5 however, be always relied upon. Both heat and cold exert 
a favorable germicidal influence. Cold causes contraction 
of the capillaries, thereby checking the amount of secretion 



PRACTICAL OPHTHALMIC NURSING 55 

and exudation, also relieving pain and retarding the forma- 
tion of pus at the beginning of acute inflammatory condi- 
tions. It is especially useful in diseases of the conjunctiva 
and after slight injuries or operations, but if used too con- 
tinuously it may interfere with the nutrition of the cornea 5 
and cause ulceration of that membrane. In traumatism 
ice-cold applications overcome inflammatory reaction, and 
it is a good practice to apply antiseptic iced compresses to ' 
even* injured eye which enters the hospital and keep it up 
until the arrival of the surgeon. 10 




Fig. 35. — Inverting the upper lid with a pencil. (Allport.) 

Heat stimulates the circulation, promotes absorption, re- 
lieves pain and reduces tension, therefore it is especially 
beneficial in deep-seated inflammations of the eyeball, such 
as iritis, cyclitis, and acute glaucoma. Hot packs are of 
special value in all forms of keratitis. The effect of heat 15 
upon the cornea will be readily understood if we but re- 
member that that membrane is non-vascular and is de- 
pendent upon the surrounding tissues for its nourishment. 
The quantity of a drug absorbed and the rapidity with 
which the absorption takes place is greatly increased by the 20 
previous application of moist heat. 



56 



THE OPHTHALMIC NURSE 



Either heat or cold may be applied in the dry or in the moist 
form, but in the majority of cases better results follow the 
moist applications, for they possess more intensity of action 
and penetrate deeper. If dry heat is required, the compress 
is held in contact with the outside of a can of boiling water 
for a few minutes, then placed over the closed lids. Moist 
heat is best applied by soaking pads consisting of seven or 
eight thicknesses of gauze or flannel, just large enough to 




Fig. 36. — Applying hot packs. 

cover the eye, in water of the desired temperature, usually as 
10 hot as can comfortably be born (115° to 125° F.), and, after 
testing same on the back of the hand, place it over the 
closed lids and cover it with a piece of oiled silk or muslin. 
The pad should be changed quickly and frequently, usually 
every two minutes. Hot packs are generally used every- two 
15 or three hours for from ten minutes to half an hour. Some- 
times in severe cases they are applied constantly for several 
hours or more. 



PRACTICAL OPHTHALMIC NURSING 



57 



In using cold packs several of the gauze or flannel pads are 
first wrung out in a 1 : 8000 bichlorid of mercury solution 
and then laid on a cake of clean ice. The change from the 
ice to the eye is made frequently enough to prevent the packs 
from getting lukewarm, as the intermittent action of cold 
is harmful to the eye. Iced packs should not be used as 
long or as frequently as hot packs; from five minutes to a 



l( 




X" 








J 


■)=-—-t 


%— 


Y 


A 



Fig. 37. — Simple method of heating hot packs. (Friedenberg.) 



half hour at a time and occasionally for several hours, ac- 
cording to the severity of the case. They should be dis- 
continued if the cornea becomes cloudy. Cold interferes io 
with the nutrition of the cornea, and for that reason cold 
packs are never used when the cornea is affected. Ice 
should never be applied to the eye. 

In using either hot or cold packs the lids and face around 



58 



THE OPHTHALMIC NURSE 



the eye should be freely anointed with steriline, cold cream, 
or almond oil to prevent unnecessary irritation of the skin. 









Jv. \ ^*X. 


V© 


C~" — ^"C^~ 


A 


it- 


- 


■W 









Fig. 38. — Iced packs. (Manhattan Hospital.) 

Ointments. — Many eye medicines are used in the form of 
salve made of vaselin or lanolin. In applying such oint- 




Fig. 39. — Applying ointment to the eye. 

5 ments to the interior of the eye the best way is to take a 
wooden toothpick, wind a little absorbent cotton tightly 



PRACTICAL OPHTHALMIC NURSING 59 

"around one end, so that there are no loose fibers, dip it into 
the ointment, have the patient look up, at the same time 
pull down the lower lid, and roll the ointment off the cotton 
on to the conjunctival surface. After the introduction of 
the ointment the lids should be vigorously massaged, taking 5 
care that the fingers do not enter between them and injure 
the eve. All superfluous ointment should then be wiped 
away. 

Powders, such as iodoform, calomel, and orthoform, are 
sometimes dusted into the eye. This is best done by dipping 10 
a wooden toothpick, which is armed with loose absorbent 
cotton, into the powder, and, while separating the lids, shake 
it off the cotton into the eye by striking the toothpick with 
the forefinger. 

Poultice. — The poultice is the greatest abomination in 15 
eye practice. I have seen poultices on the eye composed of 
tea leaves, scraped potatoes, rotten apples, and many other 
things, whose results are equally or more disastrous. There 
is not a single condition of the eye in the treatment of which 
poultices should be prescribed. 20 

Massage. — There is perhaps no organ of the body whose 
vascular and lymphatic circulation is more readily affected by 
well-regulated massage than is the eye. Besides increasing 
the circulation of the blood and lymph, it stimulates mus- 
cular action, promotes absorption, reduces tension, and re- 25 
lieves pain, and is, therefore, of special value in chronic dis- 
eases of the lids and conjunctiva, in corneal opacities, granu- 
lated lids, and subconjunctival hemorrhages. By it ab- 



6o 



THE OPHTHALMIC NURSE 



sorption is also stimulated and intra-ocular tension tem- 
porarily reduced, but it is contraindicated in all conditions 




Fig. 40. — Massage of the upper lids. (Friedenberg.) 







Fig. 41. — Massage of the lower lids. (Friedenberg.) 

in which its use is followed by redness of the eye, the in- 
creased flow of tears, and sensitiveness to light. It con- 
5 sists of gentle stroking movements made upon the closed 



PRACTICAL OPHTHALMIC NURSING 61 

eyelids with the fingers in centripetal, centrifugal, and cir- 
culatory directions. In massaging the upper lid and the 
upper part of the eyeball the patient is directed to look 
down, and in massaging the lower lid and the lower part of the 
eyeball he is directed to look up. If the cornea is to be 5 
treated, the patient is instructed to look straight ahead. In 
no instance should undue pressure be exerted upon the eye- 
ball. Ocular massage may be administered from one to 
four times a week for from three to four minutes at a time. 

Electricity, both the galvanic and the faradic, is fre- 10 
quently employed in spasmodic or paralytic affections of the 
external ocular muscles, in supra-orbital neuralgia, in pro- 
gressive atrophy of the optic nerve, hysteric affections of the 
eye, etc. 

The positive pole has a calmative action and the negative 15 
pole a stimulant action, therefore the one which is applied 
over the eye depends upon the effect desired. The other 
pole is generally applied to the nape of the neck. Usually 
from 3 to 5 milliamperes for five minutes every day or two 
will suffice. Electricity in the form of the galvanocautery is 20 
sometimes used to destroy diseased tissue and check the 
progress of corneal ulcers. This method, however, is hardly 
as safe as the actual cautery, as it is less easily controlled. 

Leeching. — Many deep-seated inflammations of the eye, 
like iritis and cyclitis, with sluggish circulation and severe 25 
pain, are benefited by the local abstraction of blood, which 
diminishes the tension upon the vessels and nerves and pro- 
motes absorption, therefore it behooves the nurse to be 



62 THE OPHTHALMIC NURSE 

thoroughly acquainted with the method of applying leeches. 
Norwegian leeches are usually the best. They absorb from 
1 to 2 drams of blood a piece and should be tested before 
applying. If all right, they will generally assume an egg 

5 shape when touched and will swim around lively when placed 
in cold water. Before applying them they should be placed 
in clear cold water and handled as little as possible. After the 
temple has been washed clean and a drop of milk placed upon 
it, f inch behind the external angle of the eye, the leeches are 

io taken, one at a time, out of the cold water by means of a 
pair of plain dressing forceps and placed in a homeopathic 




Fig. 42. — The leech. 

phial, which is held so that the leech will touch the milk. If 
unsuccessful in making it bite, a drop of blood brought by 
scratching the temple with the point of a scalpel or taken 

15 from a pin-pricked finger, may serve as better bait. When 
leeches have their fill, they will drop off, or if, for any 
reason, you should desire to remove them sooner, a pinch 
of salt or a little saleratus, or even a couple of drops of co- 
cain solution will usually suffice to dislodge them. As a 

20 rule, one or two leeches do very little good; at least six 
should be employed, or, better still, one leech may be used 
and that followed by the application of the artificial leech, 



PRACTICAL OPHTHALMIC NURSING 63 

which I have found to be a very satisfactory method of de- 
pletion, as in this way we avoid the pain caused by the 
mechanical scarifier and extract the blood more rapidly and 
at less expense than where leeches alone are employed. If 
continued bleeding is desired, this may be accomplished by 
the application of hot fomentations. If continued depletion 
is not desired, a firm pressure bandage is necessary, as bleed- 
ing of the natural leech bite is often quite difficult to check in 
any other way. Occasionally I have succeeded in dispensing 




Fig. 43. — The artificial leech. 

with the bandage by applying a pledget of cotton soaked 10 
in adrenalin chlorid or chlorid of iron and exert pressure for 
a few minutes. It is perhaps well to try this method first, 
as the pressure bandage is anything but comfortable to the 
patient. One should rest several hours after leeching. 

Counterirritants, such as tincture of iodin or cantharides, 15 
are sometimes applied at some distance from the eye for the 
purpose of reflexly influencing the affected parts. When 
counterirritation is desired the iodin or a small piece of mus- 
tard leaf may be placed behind or in front of the ear or on 



64 THE OPHTHALMIC NURSE 

the forehead and allowed to remain there for twenty minutes. 
The next day it is placed in another of the three positions 
named, and on the third day in the remaining one, so that 
on the fourth day the place originally selected will be fit for 

5 the reception of a new piece. This form of blistering is very 
efficacious and the degree of severity is easily controlled. 

Mercurial Inunctions. — One of the most important meas- 
ures of general treatment in many eye diseases is the mer- 
curial inunction, followed, in specific cases, by increasing 

to doses of potassium iodid. For inunction we generally use 
the ordinary blue mercurial ointment either alone or com- 
bined with an equal part of green soap. After washing and 
drying the skin, 20 to 30 grains of this mixture may be patted 
on until it has disappeared. The parts usually selected for 

15 this operation are the inner surfaces of the thighs and the 
under surfaces of the arms, taking a different location each 
time to avoid blistering. This procedure is repeated usually 
once a day until about 3 ounces of the ointment have been 
used unless symptoms of ptyalism, such as soreness of 

20 the teeth and guns or increased flow of saliva, are noticed. 
Proper care should be paid to the patient's teeth during the 
use of the mercurial inunction and the nurse should protect 
herself against absorption by the use of rubber gloves. Many 
intra-ocular affections even of a non-specific nature, such as 

25 iritis, cyclitis, and the various forms of sympathetic oph- 
thalmia, are also benefited by these inunctions, while the 
iodids of potash and soda are valuable adjuncts in chronic 
affections of the choroid and vitreous. 



PRACTICAL OPHTHALMIC NURSING 65 

Sweating. — Another important means of treatment in 
certain ocular diseases is diaphoresis or sweating. It is 
particularly indicated where the absorption of an exudate or 
relief of active congestion is desired, but is contraindicated in 
certain organic heart affections. Diaphoresis is best ob- 5 
tained by the administration of pilocarpin hydrochlorate 
(xo t0 e grain h}T>odermically) , beginning with small doses 
and increasing according to the results obtained. Hot 
drinks, blankets, hot mustard foot-baths, and hot-water 
bags are valuable adjuncts. This treatment should be ad- 10 
ministered on a comparatively empty stomach, and, after 
sweating for two hours, the patient should be thoroughly 
dried, then rubbed with alcohol, and afterward allowed to 
rest. 

Rest. — The eye in waking moments is always under the 15 
influence of the sensory stimuli, and is consequently more 
or less active. Therefore eye patients more than others re- 
quire plenty of sleep. If sleep is disturbed it is necessary to 
give remedies to induce it, such, for instance, as sulphonal 
(10 to 30 grains dissolved in a little hot water), several hours 20 
before bedtime; codein, gr. J; chloral, 10 to 30 grains in 
simple syrup and water, etc. Darkness does much to rest 
the eyes, and most eyes will do better in a room in which the 
amount of light has been properly regulated. In some cases 
a binocular bandage will answer the same purpose. The 25 
involuntary 7 muscles of the eye may be put at rest by the 
use of mydriatics in the proper cases. Rest of the eyes is 
not necessary in ophthalmic cases only, but all patients con- 



66 THE OPHTHALMIC NURSE 

valescing from sickness of any kind should use their eyes as 
little as possible, especially while lying down. 

Contagious Eye Diseases. — All eye diseases with a dis- 
charge are more or less contagious. The more abundant 

5 the discharge and the more it resembles pus in its appear- 
ance, the more contagious it is. It has been proved that 
under certain conditions contagious eye diseases may be 
spread through the medium of the air. Purulent cases 
should be isolated as far as possible, each patient having his 

10 own washing utensils, towels, etc., and a room which has 
been used for a purulent case should be disinfected before 
it is used for other cases. The nurse, when treating such 
cases, should wear goggles; she should keep her finger-nails 
closely clipped and afterward thoroughly brush her hands 

15 with soap and cleanse with antiseptic solution before wiping. 
In case the nurse's eyes should become infected, prompt ac- 
tion should be taken. The lid should be everted, cleansed 
with a 1 : 8000 bichlorid of mercury solution, dried, and 
then painted with a 2 per cent, solution of silver nitrate, 

20 followed by the use of cold compresses. These precautions, 
if carried out at once, will probably prevent further mischief. 
In purulent diseases limited to one eye it is important to 
prevent spreading of the discharge to the other eye or infec- 
tion by means of the patient's hands. The patient should 

25 lie on the affected side as much as possible so that the matter 
may flow away from the other eye and, after being first 
anointed with iodoform ointment (1 part to 8), the good eye 
should be sealed with a Buller's shield made from a watch 



PRACTICAL OPHTHALMIC NURSING 



67 



crystal and court plaster, leaving the temporal side open, so 
as to admit air. This shield may be worn several days at 
a time without change unless, as sometimes happens, the 
skin beneath the plaster becomes eczematous, in which case 
it must be discontinued. 

With infants, where it is difficult to keep on a Buller's 
shield, the eye may be covered with a piece of combined 
dressing, just large enough to cover the lids, which has 




Fig. 44. — Buller's shield. (Jaeffreson.) 

been previously soaked in a bichlorid of mercury solution 
(1 : 10,000) and allowed to dry. Over this is placed a piece 10 
of gutta-percha tissue large enough to cover the brow and 
part of the nose ; reaching fairly well down on the cheek. 
This tissue is securely fastened down on all sides except the 
temporal with narrow strips of adhesive plaster. This 
dressing should be removed daily and the eye inspected. 15 
The most common purulent affection of the eye is that 



68 THE OPHTHALMIC NURSE 

which is known as ophthalmia neonatorum, a disease which 
statistics show is responsible for fully 30 per cent, of the 
blindness in the United States. It usually appears on the 
third or fourth day after birth and is due to infection during 

5 birth from a leukorrheal or gonorrheal discharge. The se- 
verer forms are due to the gonococcus, which germ is cap- 
able of producing such rapid destruction of the ocular tissues 
that little time is required for the disease to secure such a 
hold that the best of treatment will be of no avail in pre- 

io venting blindness. The discharge reaches its maximum 
about the end of the second week and after that period 
begins to decline, but too often only after irreparable mis- 
chief has been inflicted in the eye. In severe cases the dis- 
ease runs a violent and rapid course, unchecked by any 

15 remedies, and quickly destroys the eye. 

The warmth and moisture of the eye make it a favorable 
ground for the growth of micro-organisms. The presence 
of a discharge, especially of a purulent nature, greatly favors 
the invasion and growth of bacteria, consequently the im- 

20 portant feature in the treatment of purulent cases is clean- 
liness. The eye should be kept constantly and thorough ly 
free from accumulations of pus by frequent antiseptic irriga- 
tions. All pus should be washed away with boric acid solu- 
tion as soon as it forms. This may have to be done in the 

25 acute stages as often as every fifteen minutes, and is best 
accomplished by means of a small soft-nibber bulb syringe. 
More depends upon this procedure for the cleansing effect 
than from any practical action of the antiseptic solutions 



PRACTICAL OPHTHALMIC NURSING 69 

used, for the latter could not be used in sufficient strength 
to have any pronounced germicidal effect without injuring 
the ocular tissues. Such solutions are, however, preferable 
to plain sterilized water. The author's irrigator is most 
convenient and useful in these cases. In shape it is similar 5 
to an eye speculum and is introduced in the same way. It is 
made of thin tubing, so that the fluid passing through the 
distal end, which is connected with a fountain syringe, finds 
its exit through a series of small holes in the parts which 
pass beneath the lids. By elevating the handle the lids 10 
may be drawn away from the eyeball and the whole of the 
bulbar and palpebral conjunctiva is freely flushed. 




SswgWBqji 



3=<£ 



Fig. 45. — The author's irrigator. 

Ophthalmia neonatorum can usually be prevented by the 
instillation of a 1 per cent, solution of silver nitrate or a 20 
per cent, solution of argyrol into the baby's eyes immediately 15 
after birth. The latter medicines should be used in the eyes 
of every newborn baby regardless of circumstances. Per- 
sonally, I do not favor such measures as dropping upon the 
delicate cornea of a baby's eyes a 2 per cent, or even a 1 
per cent, solution of silver nitrate. The use of silver nitrate 20 
is by no means the ideal prophylaxis, neither is its instillation 
into the eye the ideal treatment for ophthalmia neonatorum, 
as it causes some pain and usually more or less conjunctivitis. 
There has been reported several cases in which its use has 



70 THE OPHTHALMIC NURSE 

been followed by corneal ulceration. If there is any reason 
to expect infection, a 10-grain solution of nitrate of silver 
might be advantageously employed by brushing the same 
over the mucous membrane of the everted lid, but I would 

5 hesitate long before dropping a caustic solution of such 
strength upon the delicate cornea of a newborn babe. 

I do, however, recommend the use of argyrol, which is 
nearly as effective in preventing and aborting the disease 
and seldom causes any local irritation. The procedure should 

10 be practised as follows: As soon as the child is delivered the 
face is cleansed. This may be done with absorbent cotton 
and sterilized water, boric acid solution, or bichlorid of 
mercury solution 1 : 10,000, thus removing all secretions 
from outside the lids and lashes. The lashes are then 

15 separated and the eye flushed out with a saturated solution 
of boric acid and a few drops of a 15 to 25 per cent, solution 
of argyrol dropped in. This treatment should be followed 
up for several days unless symptoms of the disease have by 
that time developed, in which case it is continued until the 

20 eyes are well. 



CHAPTER VI 

ANTE-OPERATIVE CARE 

The well-known rules of asepsis and antisepsis which ap- 
ply to general surgery are, with slight modification, applic- 
able to eye work, and failure on the nurse's part to observe 
these rules when preparing a patient for an operation or 
when assisting in the operation and during the postoperative 5 
care would be criminal negligence. 

A cheerful, sympathetic, and observing nurse may do much 
to encourage the patient and aid the doctor. The more 
information she can impart to the surgeon concerning the 
patient, with whom she is in daily contact, the more val- 10 
uable will her assistance be to him, therefore she should 
keep strict watch for anything that is abnormal, noting the 
peculiarities and idiosyncrasies of the patient, her habits as 
regards eating, drinking, and sleeping, or the taking of nar- 
cotics. Also whether or not there are any little ailments, 15 
such as cough, cold feet, flatulence, weakness of the bladder, 
skin trouble, etc. She should also note the condition of the 
bowels, whether or not the patient is pregnant or menstruat- 
ing, and should make a memorandum of everything of im- 
portance for the surgeon. 20 

She should win the confidence and respect of the patient, 

quiet all anxiety, and encourage her as much as possible 

to expect a favorable result, and thus avoid the depressing 

71 



72 THE OPHTHALMIC NURSE 

effect of despondency and its ultimate tendency to surgical 
shock. 

The nurse should know beforehand the nature of the opera- 
tion to be performed in order that she may thereby suitably 
prepare the patient and the operating room, providing ap- 
propriate dressings, solutions, etc., as well as have some idea 
of what particular kind of attention the patient will require 
after being put to bed. 




Fig. 46. — Method of dressing the hair. (Jaefferson.) 

In all major operations where the eyeball is to be opened 
10 it is well for the patient to go to bed the day before the opera- 
tion, after first having a thorough general bath, special at- 
tention being paid to the head and face. Men should be 
previously shaved and women should have their hair dressed 
in a suitable and convenient form so that it may be 
15 out of the way and remain untouched for several days. 
After being combed well it should be parted at the back 



ANTE-OPERATIVE CARE 73 

and divided into two portions, each of which is tightly 
braided and tied with a ribbon, then rolled and fastened with 
safety-pins in a convenient roll in the hollow of the neck. The 
lashes of the eye to be operated upon should be carefully and 
closely trimmed with a pair of small curved scissors, great 5 
care beng taken that none of the hairs get into the eye. 

In some cases it is also necessary to trim the eyebrow. 
Carefully wipe away all loose hairs, then thoroughly wash 
the eyebrow, lids, lashes, and adjacent part of the face with 
green soap and sterile water, afterward thoroughly rinsing 10 
it with sterile water and 1 : 10,000 bichlorid of mercury solu- 
tion; also flush the eye with the latter solution and then 
apply a combined dressing and a bandage. 

The diet should be fluid unless otherwise ordered. A pur- 
gative should be administered on the night before the opera- 15 
tion, and on the following morning, if the desired result has 
not been obtained, an enema of soapsuds and glycerin 
should be given. One hour before the operation the dress- 
ings should be removed, the eye again flushed w T ith bichlorid 
of mercury solution, 1 : 10,000, and any other medicine or- 20 
dered by the surgeon instilled, after w T hich new dressings 
are applied. The nurse should not fail to observe the ap- 
pearance of the dressings removed, and if there is any evi- 
dence of discharge on them from the eye she should report 
the fact to the surgeon at once. 25 

Just before the patient is taken to the operating room his 
bladder should be emptied, if he has artificial teeth they 
should be removed, and he should be clothed in suitable 



74 THE OPHTHALMIC NURSE 

antiseptic attire, a sterile night gown and a rubber cap which 
covers the ears and all the hair. Some operators prefer to 
give the patient a suppository of opium or some other ano- 
dyne just before going to the operating room, especially if 

5 he is inclined to be nervous. 

When the operation is to be done at the patient's home 
the nurse should be there at least a day before, and in 
selecting a room for the operation its size and the facilities 
for ventilating and lighting should be carefully considered. 

10 If artificial light is necessary the electric light with a good 
reflector is by far the most preferable, especially where a 
general anesthetic is to be employed, as the vapor of ether 
is highly inflammable, and chloroform, when administered 
in a room with a gas or oil flame, will produce fumes which 

15 are exceedingly irritating and even dangerous to all in the 
room. 

All the hangings and movable articles should be removed 
and the room thoroughly cleaned at least twenty-four hours 
before the operation. If only a few hours' preparation is 

20 available, however, nothing in the room should be touched 
nor should any sweeping or dusting be done, but the floors 
and everything, as far as possible, should be covered with 
sheets wrung out in a 1 : 10,000 solution of bichlorid of 
mercury. 

25 Operating Table. — A kitchen table covered with a folded 
blanket, a rubber sheet, and a clean linen sheet may be used 
as the operating table, and it should be placed so as to in- 
sure good light on the proper side and be most convenient for 



ANTE-OPERATIVE CARE 75 

the operator. Three small tables should also be provided, 
two for the surgeon and one for the anesthetist. These are, 
of course, to be covered with sterile towels. Upon one should 
be placed the instruments; upon the second, the solutions, 
cotton, torpedoes, and small gauze sponges; while upon the 5 
third should be an ether cone or chloroform mask, several 
small towels, some large gauze sponges, the anesthetic, a 
hypodermic syringe loaded with y^- grain of nitroglycerin 
and -£q grain of strychnin. 

The nurse should ascertain on which side the surgeon is to 10 
stand while operating so as to arrange the tables accordingly. 

Other things to be provided are a stool for the operator to 
sit on, if he wishes to, sterile gown and cap for the operator, 
sterile droppers and several small glasses or deep dishes for 
the solutions, which are usually bichlorid of mercury, 15 
1 : 10,000; adrenalin chlorid, 1 : 3000; normal salt; cocain, 
4 per cent.; eserin, \ gr. to the ounce; atropin, 1 per cent., 
and a saturated solution of boric acid. 

In an adjoining room preparations should be made for the 
surgeon to sterilize his hands. Here should be nail picks and 20 
brushes, green soap, sterile towels, and whatever solutions 
he prefers for his hands, usually bichlorid of mercury 1 : 1000 
or carbolic acid 1 : 20, and sterile water. 

Previous to the operation the nurse should see that the 
patient's bed is properly prepared. It should be accessible 25 
from both sides, a folded sheet or bath towel should be 
placed where the head is to rest, with a rubber sheet under it 
to protect the bedding. If a general anesthetic is to be used 



76 THE OPHTHALMIC NURSE 

the bed should be warmed by hot-water bottles, no matter 
what the climatic conditions may be, for the patient's resist- 
ance is always lowered by the anesthetic. Be sure, however, 
that the bag is not too hot, as many malpractice suits have 

5 originated from burns thus produced. All of these prepara- 
tions should be completed at least an hour or two before the 
surgeon's arrival and without unduly attracting the patient's 
attention. 

It must be remembered thai the instruments of the oculist, 

10 especially the cutting ones, are the most delicate used in 




Fig. 47. — Using the test-drum. 

surgery. They must have such an edge that when lying 
on the palm of the hand they will perforate the test-drum by 
the force of their weight. Their edges and points are, 
therefore, so easily blunted that they require the most care- 

15 ful manipulation. Boiling them too long, leaving them in 
formalin too long, wiping them carelessly with cotton or 
touching the points with the fingers will injure them. 

All but the cutting instruments and those with ivory 
handles should be scrubbed with a tooth-brush in soap and 

20 water, then sterilized by boiling for ten minutes in a solu- 
tion of bicarbonate of soda (1 dram to 10 quarts of water), 



ANTE-OPERATIVE CARE 77 

after which they are immersed in alcohol for a few moments, 
and finally rinsed in sterile water. 

The cutting instruments should first be tested on a test- 
drum, which consists of a piece of beetle skin or thin kid 
tightly stretched between two hard-rubber rings, very much 5 
in the way linen is stretched for working. They should then 
be held in boiling water for a quarter of a minute, then placed 
in formalin (1 : 10) for a couple of minutes, then in alcohol 
for five minutes, and finally rinsed in sterile water, and 
carefully wiped with soft linen. Do not wipe with cotton or 10 
some of the fibers may cling to the instrument and be in- 



Fig. 48. — The instrument tray. 

troduced into the eye. To make sure that such a mistake 
may not occur it is well to examine each one with a magni- 
fying glass. Never touch the points or allow them to come 
in contact with other instruments, therefore it is well to use 15 
the glass tray which is made purposely for them. This tray 
has a series of grooves which support the handles of the in- 
struments while the blades are free. All other instruments 
ma}- be placed on towels which have been previously wrung 
out in a 1 : 20 carbolic solution. 20 

All solutions should be previously prepared with sterilized 
or distilled water and, if convenient, it is better to have them 
lukewarm. When the operation is to be performed at the 



78 THE OPHTHALMIC NURSE 

patient's home it is a good idea to have all solutions in bot- 
tles, each one being labeled and sealed with a slip of paper, 
which is not to be broken until needed, at which time a 
sterile dropper is put in each one and placed where it can 

5 be easily reached by the operator. 

The sterilization of dressings and bandages is a procedure 
with which you are all acquainted. Here the principal point 
to remember is that dry heat is much less efficient as a 
germicide than steam on account of its inferior penetrating 

10 power. For this reason it is better to steam them first, then 
dry them. 

The usual dressings after eye operations are small linen 
disks or eye-pieces, torpedoes of absorbent cotton, and gauze 
bandages 2 inches wide and from 4 to 6 yards long. 

15 When we stop to consider that the surgeon, in doing opera- 
tions upon the eye, seldom touches the parts with his hands, 
but that the nurse is obliged to handle sponges, dressings, 
etc., we can realize how necessary it is for her to have her 
hands in an absolutely sterile condition. 

20 After carefully cleansing and paring the nails, the hands 
and arms should be thoroughly scrubbed with green soap and 
hot water, then thoroughly rinsed in sterile water, and finally 
in a hot bichlorid of mercury solution 1 : 3000 or a 1 : 20 car- 
bolic acid solution and wiped with a sterile towel. When a 

25 bichlorid of mercury solution is used it is well to remember 
that this germicide is readily precipitated by soap, hence it 
is necessary to thoroughly rinse the hands with the sterile 
water before immersing them in the bichlorid solution 



CHAPTER VII 
IN THE OPERATING ROOM 

The operator is dependent to no small degree upon the 
efficiency of the nurse who assists him. When the patient 
is brought into the operating room she should remove the 
dressings, cover the rubber hood with a sterile towel, passing 
it under the nape of the neck and fastening it with a safety- 5 
pin over the forehead, so that the ends can be brought back 
and tucked in under the occiput. The eye should then be 
flushed both inside and outside with a 1 : 10,000 bichlorid of 
mercury solution, then with normal salt solution, after which 
it is anesthetized. 10 

The nurse should familiarize herself with the technic of 
the various operations, and should pay strict attention to 
the successive steps, so that she may anticipate the surgeon's 
need and have each instrument ready and at hand almost 
before it is asked for. She should never lay instruments upon 1 5 
the operating table, but should hand them directly to the 
surgeon. 

If the temperature of the operating room is above 72° F. 
a second nurse should stand ready with a towel to dry the 
forehead and face of the operator, to prevent the possibility 20 
of drops of perspiration falling on the operative field. 

Dressings. — After the completion of the operation the 
nurse should stand ready to apply the dressings. If the 

79 



8o 



THE OPHTHALMIC NURSE 



operation is one which requires opening the eyeball, like 
cataract extraction or iridectomy, both eyes are first covered 
with the so-called Knapp dressing, which consists of absorbent 




Fig. 49. — The Knapp dressing (single). 

cotton about J inch thick between two pieces of soft linen so 
5 shaped as to nicely cover each eye, joined by a narrow 




Fig. 50. — The figure-of-8 bandage. 



bridge across the nose. These pads are first smeared with 
steriline and then laid over the eyes and fastened down with 
narrow strips of adhesive plaster. Then the figure-of-8 ban- 



IN THE OPERATING ROOM 



8i 



dage is applied, so called because being brought alternately 
around the head and diagonally up over each cheek and eye, 
so that every turn overlaps the preceding one, it resembles 
in shape the figure after which it is named. 

For operations which do not require opening of the eye- 
ball the monocular bandage is used. This is applied by 
passing it alternately across the eye and under the ear, then 
across the eye and over the ear. 




Fig. 51. — Monocular bandage. 



Eye bandages are usually applied for one of two pur- 
poses — for pressure or for protection. The former is ap- 10 
plied to check bleeding after removal of the eye, to prevent 
ecchymosis of the blood after muscle operations, etc. The 
latter is used to keep the lids immovable after such operations 
as cataract, and if too tight may do irreparable harm. In 
applying it, however, the nurse should take care to fill the 15 
hollow of the orbit with bits of cotton until a level surface 
is obtained so as to avoid unequal pressure on the eyeball, 
and 1-inch safety-pins should be employed instead of com- 



82 THE OPHTHALMIC NURSE 

mon pins, placing one over the forehead, one on each side, 
and one in the back. Should a protective bandage at any 
time seem uncomfortably tight to the patient, the nurse 
should cut a slit about \ inch across it just under or both 

5 under and above the ears. Should it become disarranged 
and the surgeon is not accessible, the nurse should remove 
it, and, without disturbing the lids in the least, should re- 
bandage, taking special care not to get it too tight. A very 
good idea in some cases is to apply splints to the patient's 

10 elbows, which prevent him from interfering with the ban- 
dage. Should discharge or blood show through a pressure 
bandage, the nurse should sprinkle iodoform over it and 
apply another bandage, as organisms can very easily work 
their way along a tract from which discharge has washed 

15 away and exhausted the original antiseptic. If such a pro- 
cedure fails to check the hemorrhage, the surgeon must be 
informed. 

If the operation has been done under a local anesthetic, 
especially for such operations as cataract or iridectomy, 

20 care should be taken in removing the patient from the operat- 
ing table. He should be instructed to stiffen his body, relax 
the neck, and hold the mouth open while being moved. 

If the operation has been done under a general anesthetic 
the anesthetist should remain with the patient until the 

25 nurse has had time to remove the floor coverings, soiled 
sponges, and all traces of the operation as far as possible, as 
it would be unwise to permit any member of the family to 
do this. A fresh gown should be kept ready in case the first 



IN THE OPERATING ROOM 83 

one is soiled. Before putting away the instruments wash 
them with soap and water and dip them in absolute alcohol. 
This speedily evaporates and leaves them perfectly dry. 

All tissues, tumors, etc., removed by the surgeon must be 
carefully preserved, placed in a small wide-mouthed bottle, 
filled with preserving fluid (alcohol or formalin 1 : 10), and 
labeled with the patient's name, the surgeon's name, and the 
date of operation. 



CHAPTER VIII 
POSTOPERATIVE NURSING 

No matter how skilful an operator may be, his efforts will 
be fruitless and his ability frustrated unless the subsequent 
management of his cases is carefully and intelligently car- 
ried out. An injudicious movement, as getting out of bed 

5 for purposes of nature, a cold draft from a window or door, 
a single rough manipulation of the eye while dressing it, may 
ruin the most carefully performed operation, destroying the 
eye, or perhaps, with less disastrous results, prolonging the 
treatment for weeks or months. Therefore it is evident how 

10 much depends upon the care and watchfulness of the nurse 
in charge, and upon her ability to meet every emergency. 

After general anesthesia the patient should be watched 
constantly for awhile, because, in his semiconsciousness, he 
may tear off the bandages or injure the eye. The nurse 

1 5 should keep the patient as still as possible and should exclude 
friends and members of the family from the room, at least 
until the intoxicating effects of the anesthetic have worn off. 
The room should be properly heated and ventilated with- 
out any draft over the bed. This can usually be avoided by 

20 dropping the window slightly from above or by placing a 

large screen between the window and the bed. Many cases 

of iritis following iridectomies and cataract extraction have 

resulted from such exposure. 
84 



POSTOPERATIVE NURSING 85 

Patients with both eyes bandaged should not be allowed 
to feed themselves or to take a single step without guidance. 

The temperature should be taken at least twice a day. 
A slight rise in temperature just after an operation is to be 
expected, but a sudden rise after it has been running a 5 
regular course or a subnormal temperature should be 
promptly reported to the surgeon. 

For a few hours following an iridectomy or a cataract ex- 
traction the patient will complain of a slight burning pain. 
Any marked pain should be reported to the surgeon at once. 10 
Sometimes elevation of the head by an extra pillow, thus 
relieving some of the blood-pressure, will lessen the pain. 
It is a safe plan to administer J grain of codein every three 
hours for several doses. 

If there is evidence of a chill or sudden weakness, place 15 
hot- water bottles to the feet, elevate the head of the bed, 
and give stimulants. 

If the patient feels disposed to sneeze he should be advised 
to press his upper lip forcibly against the upper teeth. If 
there is a tendency for the patient to vomit, lower the head 20 
by removing the pillow, fan him and give him some ice to 
suck, a little lemon-juice, beaten white of egg, or milk and 
lime-water; also apply a mustard plaster over the stomach. 
If the patient does vomit, the nurse should support his head, 
taking care not to exert any pressure over the bandage, and 25 
after vomiting the mouth should be rinsed out with some 
antiseptic solution such as listerine. 

Shock seldom follows operations on the eye, but when it 



86 THE OPHTHALMIC NURSE 

does occur the nurse should be able to recognize it and know- 
how to meet it. The symptoms of shock are dilated and 
sluggish pupils, irregular, weak pulse, a clammy, cold skin, 
nausea or vomiting, and a loss of control of the bowels or 

5 bladder. At such a time the patient's head should be low- 
ered, the lower extremities bandaged, hot water applied, 
and an enema of black coffee and brandy administered. 

As a large percentage of the operative eye cases consist 
of cataract extractions, and as the results in such cases de- 

10 pend so much upon their postoperative care, it might be 
well to devote a little time to this specialty. 

If suppuration, iritis, or prolapse of the iris takes place 
during the care of a patient who has been successfully oper- 
ated on for cataract it is natural to suppose that there has 

15 been some lack of skill or attention on the nurse's part, 

therefore she must be constantly on guard to prevent the 

patient from moving about in bed, touching the bandage, or 

lifting the head. 

The first twenty-four hours after a cataract operation is 

20 of the greatest importance. During that time, in healthy 
and vigorous patients, the corneal wound will become se- 
curely closed, the anterior chamber re-established, and all 
danger of prolapse of iris or vitreous passed, therefore during 
that time the patient should lie mostly on his back with 

25 his head moderately elevated. If he is restless or finds his 
position too irksome the nurse should gently roll him over 
on the non-operated side and support his back with a pillow 
or two. 



POSTOPERATIVE NURSING 87 

During the first few days no food should be given which 
requires masticating, but fluids should be taken through a 
tube. A cathartic having been given on the day preceding 
the operation, no solid food having been taken, and codein 
having been administered, there is not likely to be any 5 
evacuation of the bowels for two or three days following the 
operation, at least such may be hoped for, as the straining 
which usually accompanies defecation is liable to cause pro- 
lapse of the iris through the corneal wound. For this reason 
cathartics should never be administered to cataract cases 10 
within three days after operation. 

Some elderly patients have difficulty in urinating while 
lying down. In such cases apply hot compresses over the 
bladder or pass a catheter. 

If the patient persists in interfering with the bandage, 15 
splints should be placed on the elbows so as to make it im- 
possible for him to get his hands up to his eyes. 

Many cataract cases suffer depression resulting from the 
occlusion of both eyes and from anxiety over the results 
of the operation. This may be warded off by the nurse 20 
reassurring them, reading to them, and in every way divert-, 
ing their attention from their affliction. 

Usually on the fifth or sixth day the bandage is removed 
from the non-operated eye. At this time the nurse should 
see that the room is darkened and that the window shade 25 
is not allowed to blow back and forth by the wind, so that 
flashes of sunlight enter. On the seventh or eighth day the 
operated eye is uncovered, and during the following two or 



88 



THE OPHTHALMIC NURSE 



three days the room is made gradually lighter until the 
patient can stand ordinary daylight, at which time he is 
allowed to go home. 

Following cataract operations rigid antiseptic precautions 
should be observed each time the eye is dressed, therefore 
the nurse must see to it that when the surgeon calls every- 
thing in the line- of sterile solutions and dressings are pre- 
pared. Cut the bandage and remove all but the pads next to 
the eye. These should be left for the surgeon to remove 




Fig. 52. — The eye tray. 



10 himself, as their condition, whether soiled or not, is an 
indication of the patient's progress. Place a sterile towel 
under and over the patient's head and have your eye 
tray ready, with its contents carefully arranged, so the 
surgeon can quickly place his hands on anything he 

15 wants, and always make sure that the tray contains the 
following articles: torpedoes of absorbent cotton (long 
fibered); medicine-droppers; wooden toothpicks; eye-pieces 
of combined dressing (single and double); adhesive plaster; 



POSTOPERATIVE NURSING 89 

bandage (2 inches wide); small pus basin; atropin solution 
(1 per cent.); cocain solution (4 per cent.); eserin solution 
(J grain to the ounce); silver nitrate 2 per cent, (in blue or 
amber bottle); safety-pins; tube of steriline; sterile towels; 
bandage scissors; probe; dressing forceps, and a candle. A 
warm solution of boric acid (saturated) and hgd. bichlorid 
(1 : 10,000) should also be freshly prepared. 



CHAPTER IX 

OPHTHALMIC MATERIA MEDICA 

We will very briefly consider the use, action, and prepara- 
tion of some of the medicines used in ophthalmology. By 
"some" I mean those only which are used in every-day prac- 
tice. These we will consider alphabetically, after first de- 
5 fining the different classes under which most of them belong. 
Local anesthetics are medicines which paralyze the sensory 
nerve-endings of the part to which they are applied and pro- 
duce a loss of sensation in that part. The large majority of 
ophthalmic operations are performed under the influence of 
10 some local anesthetic. 

Among the agents of this group are alypin, cocain, eucain, 
holocain, and novocain. 

Analgesics (local sedatives) are remedies which diminish 
the nervous and vascular irritability or excitement by rc- 
15 ducing the functional activity of the part to which they are 
applied. They, consequently, relieve local inflammation 
and pain. Only those that are used for their local action 
will be mentioned in this book. 

They are atropin, belladonna, camphor, cocain, dionin, 
20 duboisin, eserin, homatropin, hyoscin, lead acetate, opium, 
pyoctanin, and scopolamin. 

Antiseptics are remedies which destroy, arrest, or restrict 

the growth of pathogenic micro-organisms and neutralize or 
90 



OPHTHALMIC MATERIA MEDICA 9 1 

destroy the toxic products of these micro-organisms. They 
are, consequently, useful after operations or injuries, to pre- 
vent infection, also in the treatment of those diseases of the 
eye which are due to the presence of micro-organisms, and for 
the sterilization of the hands, dressings, instruments, etc. 5 

Actol, alum, argentamin, argonin, argyrol, aristol, boric 
acid, calomel, camphor, carbolic acid, chlorin-water, for- 
malin, glycerin, iodin tincture, iodoform, mercury bichlorid, 
mercury cyanid, resorcin, salicylic acid, silver nitrate, so- 
dium bicarbonate, sodium borate, tannic acid, zinc sulphate. 10 

Astringents are remedies which cause contraction of the 
capillar}' blood-vessels in the parts to which they are applied, 
thus lessening the secretion and the blood-supply. They 
coagulate albumin and check hemorrhage and morbid 
discharge, and, if used in strong solutions, may act as 15 
caustics. 

Actol, adrenalin chlorid, adrin, alum sulphate, argen- 
tamin, copper sulphate, hamamelis, lead acetate, mercury, 
peroxid of hydrogen, silver and its salts, argyrol, protargol, 
etc., tannic acid. 20 

Caustics or escharotics are substances which destroy tis- 
sues when applied to them locally, and are most frequently 
used in eye work to destroy the diseased tissue of an ulcerated 
cornea, so that the remedies to follow will come in contact 
with the healthy corneal tissue. 25 

Acetic acid (glacial), alum sulphate, carbolic acid, copper 
sulphate, mercury bichlorid, mercury yellow oxid, silver 
nitrate, zinc sulphate. 



02 THE OPHTHALMIC NURSE 

Counterirritants are remedies used to produce an irrita- 
tion in one part of the body in order to counteract a morbid 
condition in another part. 

Cantharides, croton oil, mustard. 
5 Disinfectants are agents which destroy the causes of in- 
fection. 

Hydrogen peroxid, itrol, lysol, potassium permanganate, 
pyoctanin. 

Emollients are remedies of a bland, soothing character 
10 which, when applied to a part, protect it from friction and 
from the air, relieve tension, and diminish pain. 

Acacia, castor oil, cocoa-butter, glycerin, lard, olive oil, 
starch, vaselin. 

Escharotics. — See C \i ustics . 
15 Germicides. — Remedies which have the power of destroy- 
ing micro-organisms. See Antiseptics. 

Hemostatics are remedies which arrest hemorrhage. See 
Astringents. 

Irritants are remedies which increase the vascularity of the 
20 parts to which they are applied, thus increasing the power of 
absorption. According to the degree of their action they 
are classed as rubefacients, those which simply redden the 
surface; epispastics or vesicants, which occasion blisters; and 
pustulants, which excite sufficient inflammation to form pus. 
25 When corneal ulcers become indolent an irritant starts the 
healing process. 

Arnica, cantharides, capsicum, chloroform, croton oil, 
ether, iodin tincture, mustard, silver nitrate, turpentine. 



OPHTHALMIC MATERIA MEDICA 93 

Lymphagogues are remedies which promote the formation 
of lymph in the parts to which they are applied. 

Dionin. 

Mydriatics are medicines which dilate the pupil by par- 
alyzing the sphincter muscle or by stimulating the dilator 5 
muscle of the iris. They also more or less increase the ten- 
sion of the eyeball. 

Atropin sulphate, belladonna, cocain, duboisin, euph- 
thalmin, homatropin, hyoscyamin, hyoscin, mydrin, sco- 
polamin. 10 

Myotics contract the pupil by paralyzing the dilator muscle 
or by stimulating the sphincter muscle of the iris. They 
also reduce the tension of the eyeball. In other words, my- 
otics have just the opposite effect on the eye that mydriatics 
do. Right here it might be stated that all medicines which 15 
dilate the pupil increase the intra-ocular tension, while all 
medicines which contract the pupil diminish it. 

Eserin^pilocarpin .... 

Refrigerants have the effect of cooling or reducing the 
temperature of the parts to which they are applied. 20 

Vinegar. 

Rubefacients are remedies which when applied to a part 
cause redness of that part. See Irritants. 

Sedatives (local) are medicines which when applied to a 
part allay the irritability. See Analgesics. 25 

Staining agents are remedies which are employed in map- 
ping out defects in the corneal epithelium, to determine the 
limits of corneal ulcerations, and the exact location of foreign 



94 THE OPHTHALMIC NURSE 

bodies. Dropped into the conjunctival sac they stain the 
defective area so that the contrasting color is readily seen. 

Argyrol, fluorescein, pyoctanin. 

Stimulants are medicines which have the power to excite 
5 organic action or to increase the vital activity of an organ. 

Eserin, mercury yellow oxid, silver nitrate, and other 
silver salts, such as argyrol, protargol, etc. 

Styptics are remedies which have the power of checking 

hemorrhage through an astringent quality. See Astringents. 

10 Vasoconstrictors are remedies which cause contraction of 

the capillary blood-vessels of the part to which they are 

applied. 

Adrenalin chlorid and other suprarenal preparations. 

Vasodilators are remedies which cause dilation of the cap- 
15 illary blood-vessels of the part to which they are applied. 

Dionin, amyl nitrate (when inhaled). 

Vesicants are agents which, when applied to a part, cause 
the exudation of a thin serous fluid under the skin. See 
Irritants. 



CHAPTER X 
CONSIDERATION OF OPHTHALMIC REMEDIES 

Acacia, Gum Arabic (Emollient). — A gummy exudate from 
the Acacia denegal. Soluble in water. Valuable for its 
soothing effect and adhesive qualities. Used as a vehicle. 
Occasionally dusted into the eye for burns. 

Acetate of Lead. — See Plumbi Acetate. 5 

Acetic Acid. — The acid of common vinegar. Astringent 
and refrigerant. It is of value in neutralizing burns of the 
conjunctiva and eyeball from caustic soda, potash, or lime. 
The immediate instillation of diluted vinegar in such cases 
will greatly lessen the harmful effects. 10 

Glacial acetic acid, nearly or quite absolute acetic acid, is 
a caustic. 

Acid, Boric. — See Boric Acid. 

Acid, Carbolic. — See Carbolic Acid. 

Acid, Tannic. — See Tannic Acid. 15 

Acoin is a local anesthetic which does not affect the pupil, 
accommodation, or tension of the eye. It is especially used 
for subconjunctival injection in a 1 per cent, solution with 
a cyanid of mercury or mineral salt solution. Like holocain, 
it acts upon the alkali of glass, therefore it should be mixed 20 
in a porcelain vessel with distilled water. 

95 



96 THE OPHTHALMIC NURSE 

A 1 per cent, solution of acoin in oil is one of the best 
analgesics for painful eyes from any cause. A few drops 
relieve the pain for several hours. 

Solutions of acoin should be kept in the dark, as they are 
5 altered by the light. 

Actol (Lactate of Lead). — Astringent and powerful anti- 
septic. One of the best of the germicidal inorganic silver 
salts used in ophthalmic practice. 

Adrenalin Chlorid (Astringent and Hemostatic). — Derived 
io from suprarenal capsules and preserved by the addition of 
5 per cent, chlorotone in solution 1 : 1000, is both an 
astringent and a hemostatic. It is of inestimable value in a 
great many affections of the eye, especially all highly in- 
flamed conditions, as it contracts the capillaries and drives 
15 away the blood from the part, thus assisting in the absorp- 
tion of other remedies. In iritis with adhesions, where a 
complete and rapid effect of the atropin is desired, the in- 
stillation of a few drops of a 1 : 4000 adrenalin solution five 
minutes before using the atropin will greatly assist in its 
20 action. Cocain seems to reinforce the action of adrenalin 
and is a valuable adjunct. 

It is especially useful in preventing hemorrhage during 

operations on the eye. None of the suprarenal derivatives 

should be used at regular intervals for any great length of 

25 time, as the continued effects interfere with the nutrition of 

the cornea and produce ulceration of that membrane. 

Adrenalin chlorid turns to a light amber color on exposure 
to air and light, but this change does not effect its activity. 



CONSIDERATION OF OPHTHALMIC REMEDIES 97 

Adrin is another suprarenal product. It is an astringent, 
vasoconstrictor, styptic, and hemostatic, and is probably 
identical with adrenalin chlorid. 

Alum sulphate (sulphate of aluminum and potassium) is 
a powerful astringent and styptic. The pure crystal is 5 
sometimes applied to the everted lids in cases of inflamma- 
tion of the palpebral conjunctiva. A solution of 5 or 6 
grains to the ounce of sterile water is beneficial to sockets 
that carry artificial eyes. In such cases it lessens the muco- 
purulent discharge and renders the mucous membrane less 10 
susceptible to irritation from the artificial shell. It is fre- 
quently applied to the conjunctiva in the form of the solid 
crystal. Alum should never be used in the eye where there 
is any abrasion or disease of the cornea. 

Burnt alum forms a mild escharotic and powerful astrin- 15 
gent, and as such has been used in granular masses and fun- 
gating wounds of the lid, globe, and orbit. 

Alypin. — A local anesthetic which is derived from glyc- 
erin. Its anesthetic action is somewhat greater than that of 
cocain, while its toxicity is only about half that of the latter 20 
drug. A 4 per cent, solution causes complete anesthesia of 
the cornea in two or three minutes, and provokes no myd- 
riasis or disturbance of accommodation, but, unfortu- 
nately, it causes a transitory yet troublesome turbidity of 
the corneal surface, with shedding of epithelium. A 2 to 4 25 
per cent, solution is quite stable, but weaker solutions are 
likely to become moldy. It will keep better if protected 
from the light and air. 



98 THE OPHTHALMIC NURSE 

Amyl Nitrite. — A vasomotor dilator. It is never used 
locally in eye diseases, but is generally inhaled as a cardiac 
stimulant. For this purpose it is put on the market in 
pearls, made of thin glass, each containing from 2 to 5 min- 

5 ims of the drug. One of these is crushed in a piece of gauze 
or handkerchief and slowly inhaled. When inhaled it will 
temporarily improve vision, in cases of atrophy or anemia of 
the optic nerve, by stimulating the heart's action and in- 
creasing the supply of blood to the starved nerve tissue. For 

io this reason it is frequently used in tobacco amblyopia partly 
as a remedy and partly to determine whether a temporary 
improvement in vision will follow its use, in which case the 
prognosis is decidedly more favorable. 
Argentine Nitras. — See Stiver X Urate. 

15 Argonin is prepared by adding silver nitrate to the sodium 
compound of casein. It contains 4 per cent, of silver and 
is but slightly soluble in water. 

It penetrates more deeply than silver nitrate and does not 
coagulate the albumin. A 3 per cent, solution is of use in 

20 conjunctival affections where silver is indicated. It is espe- 
cially useful in ophthalmia neonatorum, as it destroys the 
gonococcus very rapidly and irritates very little. 

Argyrol, a combination of silver with albumin, containing 
from 20 to 25 per cent, of the metal, is one of the most val- 

25 uable silver salts used in ophthalmology, as it is antiseptic, 
non-toxic, and free from the irritating character of silver 
nitrate. It is used in solutions of from 6 to 30 per cent., and 
is of special value in all forms of conjunctivitis with free 



CONSIDERATION OF OPHTHALMIC REMEDIES 99 

discharge, and in catarrh of the lacrimal sac or duct. In 
using it great care should be taken not to get it on the cloth- 
ing, as its stains are difficult to remove. When used for any 
length of time in a baby's eyes only 1 drop should be in- 
stilled, as it may run down the lacrimal duct into the nose 5 
and throat, sooner or later causing systemic disturbance. 
If used too continuously, like other silver salts, it will stain 
the conjunctiva. Old solutions are more apt to irritate 
and stain the conjunctiva than fresh ones. It is prone to 
deteriorate when exposed to light, air, or heat, and should, 10 
therefore, be kept in a cool place and in tightly corked col- 
ored bottles. 

Aristol (thymol iodin) is a reddish-brown powder made 
by the action of iodin, potassium iodid, and sodium hydroxid 
or thymol, contains about 40 per cent, of iodin and is a sub- 15 
stitute for iodoform in dressing wounds. It seems to be 
about as efficacious as iodoform and is much less disagree- 
able to the patient, as it has no offensive odor. It is fre- 
quently used as a dressing in operations on the eyelids and 
after enucleation of the globe. It is also used as an irritant 20 
in indolent ulcers of the cornea and in the form of an oint- 
ment (8 per cent.) in blepharitis. When applied to mucous 
membranes it promotes secretion. 

Atropin, next to boric acid, is probably the most com- 
monly used drug in ophthalmology, and, I might say also, 25 
the most commonly misused. It is the active principle of 
belladonna and is usually employed in from \ to 2 per cent, 
solutions. It dilates the pupil and paralyzes the accom- 



ioo THE OPHTHALMIC NURSE 

modation, and consequently is usually employed in those 
diseases where both complete continuous mydriasis and 
cyclopegia are desired for a length of time, as in iritis, cyclitis, 
corneal ulcers, etc., in which diseases it also acts as an ano- 

5 dyne and sedative, relieving pain and counteracting inflam- 
mation. Its effects are complete in a half-hour after the in- 
stillation, and last from eight to ten days after the instilla- 
tions are discontinued. In suitable cases atropin will do much 
good, but in unsuitable cases it may do irreparable harm. It 

10 is practically contraindicated in most conjunctival affections 
and in glaucoma, and should always be used with great 
caution in elderly people, especially if their anterior cham- 
bers are shallow. Some people are extremely susceptible 
to atropin, even in mild doses, and, as a rule, light com- 

15 plexioned people are more susceptible to it than dark 
ones. The symptoms of atropin poisoning are redness and 
swelling of the lids and conjunctiva, dryness of the throat, 
difficulty in swallowing, slight dizziness, flushed >kin. rapid, 
bounding pulse, restlessness, delirium, and coma. Anti- 

20 dotes for atropin or belladonna are morphin, caffein, coffee, 
whisky, strychnin, and digitalis. Another point which I 
might mention here is, that the nurse should thoroughly 
wash her hands after applying atropin to avoid the danger of 
dilating her own pupils. The toxic effects of atropin are less 

25 apt to occur when it is employed in the form of an ointment. 
Beta-eucain. — See Eucain. 
Bicarbonate of Soda. — See Sodium Bicarbonate. 
Bichlorid of Mercury.— See Mercury Bichlorid. 



CONSIDERATION OF OPHTHALMIC REMEDIES ioi 

Boric acid or boracic acid is a mild and non-irritating anti- 
septic obtained by heating borax with hydrochloric acid, and 
allowing the crystals to separate. It is without doubt the 
most commonly used drug in ophthalmology throughout the 
world. It is soothing and is generally used in a saturated 5 
solution, which is about 18 grains to the ounce, although oc- 
casionally, even in weaker solution, it is not well borne and 
irritates more or less. Considerable depends upon the 
make of the acid used. Perhaps the most thoroughly re- 
liable is Squibbs. The addition of an equal part of borax 10 
renders the acid more soluble and at the same time adds to 
its effectiveness. A large bottle of the saturated solution 
should be always kept on hand, as freshly made solutions 
are apt to contain more or less of the undissolved crystals, 
which, if introduced in the eye under certain conditions, may 15 
do considerable damage. The easiest and most simple 
method of preparing a saturated solution of boric acid is to 
take two large bottles, fill one nearly full of distilled or 
boiled water, put in a lot of powder, more than will dissolve, 
shake the bottle for a few moments and allow it to stand 20 
over night, during which time the undissolved crystals will 
settle to the bottom of the bottle and a clear solution can 
then be gently poured or siphoned off into the other bottle. 
I emphasize the use of cold water, for if warm is used the 
solution will be filled with floating crystals of boric acid 25 
when it becomes cold. Boric acid ointment in the strength 
of 10 grains to the ounce is a valuable non-irritating and 
mildly antiseptic ointment for the eye. 



102 THE OPHTHALMIC NURSE 

Calomel (mercurous chlorid) dusted into the eye is useful 
as an irritant to stimulate the healing of indolent ulcers of 
the cornea, but it should never be used while the iodids are 
being administered internally, unless several hours have 

5 elapsed since the last dose, as there would then be danger of 
iodid of mercury forming in the eyes, which would be more 
or less irritating. 

Camphor is a crystal which deposits under the bark of the 
camphor tree. 

10 Camphor-water, 8 parts of camphor in 1000 parts of 

water, is one of the oldest eye-waters mentioned in the 

Pharmacopoeia. It is soothing and mildly astringent, and 

is frequently used as a vehicle for other eye remedies. 

Cantharides (Spanish flies) is used as a counterirritant in 

15 deep-seated and painful inflammations of the eye. A small 
plaster of the desired size may be applied over the temple 
and allowed to remain until a blister forms. The plaster is 
then removed, the bleb pinched to allow the escape of the 
serum, and then dressed with a boric acid, aristol, or zinc 

20 oxid ointment. Combined with collodion it can be con- 
veniently applied with a camel's-hair brush. 

Carbolic Acid (Phenol). — An antiseptic and local anes- 
thetic obtained during the instillation of coal-tar between 
the temperature of 180° and 190° C. 

25 Pure carbolic acid is crystalline at ordinary temperature, 
and is at first colorless, but reddens after exposure to the air. 
It is liquefied by 5 per cent, of water. Carbolic acid will 
destroy germ life quickly, and its effects penetrate deeper 



CONSIDERATION OF OPHTHALMIC REMEDIES 103 

than do those of corrosive sublimate. It is sometimes used 
in from J to 5 per cent, solution for irrigating the eye, and 
in the full strength for cauterizing corneal ulcers, but none 
but the absolute phenol should be used, as the regular com- 
mercial product is irritating to the eye. For the latter pur- 5 
pose a 95 per cent, mixture with glycerin is preferable. After 
staining the cornea with fluorescein, irrigating and anesthetiz- 
ing the globe, the diseased area is gently touched with the end 
of a wooden toothpick which has been soaked in the solu- 
tion. A 1 to 20 per cent, solution is frequently used for ster- 10 
ilizing hands and instruments, but the latter should not be 
allowed to remain in it more than a few minutes, and should 
then be taken out and dipped in alcohol or boiling water. 

Castor oil (oleum ricini) is an oil expressed from the seeds 
of the castor oil bean. Its bland viscid properties render it 15 
peculiarly valuable for instilling into the conjunctival sac as 
a protective and sedative, and is especially useful as a pro- 
tection to the cornea when the lids are rough and inflamed, 
as in acute trachoma. It is one of the best solvents for 
alkaloids used in ophthalmology. 20 

Cherry laurel water is distilled from the fresh leaves of the 
Prunus laurocerasus. It is used considerably in Europe, 
but very little in this country, as a vehicle for other remedies. 

Chlorin-water (Labarraque's solution) is a clear greenish- 
yellow liquid containing t 3 q of 1 per cent, chlorin and possess- 25 
ing astringent and antiseptic properties, being a favorite old 
remedy in purulent affections of the eye, as it prevents sup- 
puration without injury to the cornea. It is generally used 



104 THE OPHTHALMIC NURSE 

with water in the proportion of 1 to 4. It should be kept 
well corked and in a cool place, as it deteriorates rapidly. 

Cocain (local anesthetic), the alkaloid of cocoa leaves, is 
another one of the most frequently used ophthalmic rem- 

5 edies. It is employed in solutions of from 1 to 10 per cent., 
a 4 per cent, solution being the most commonly employed. 
The solutions should be sterilized or prepared from distilled 
water and should contain about 10 grains of boric acid to 
the ounce, which acts as a preservative and prevents the 

io formation of a fungus growth which otherwise would occur. 
When first dropped into the eye a cocain solution will smart 
for a minute or two. This smarting can be prevented by 
having the patient look upward and drop the solution in 
the lower culdesac, thus preventing it from coming in con- 

15 tact with the cornea until a few seconds after the conjunctiva 
has been impregnated. Besides its anesthetic effects, cocain 
contracts the capillaries, dilates the pupil, and has a tendencv 
to slightly increase the intra-ocular tension, therefore great 
care should be exercised in using it on elderly people, and es- 

20 pecially those with glaucomatous symptoms. When employed 
for its anesthetic effects, it is generally used in both eyes, even 
when the operation is limited to one, as it renders the act of 
winking less frequent and enables the patient to hold the 
eyes more steady. If thorough anesthesia is desired, a few 

25 drops of the solution should be instilled four or five times at 
intervals of five minutes, the patient keeping his lids closed 
between the instillations to prevent the cornea from becoming 
dry. The insensibility produced by cocain lasts about fif- 



CONSIDERATION OF OPHTHALMIC REMEDIES 105 

teen minutes and the maximum effects are reached in about 
eight minutes. If the operation lasts over ten or twelve 
minutes then the nurse should be prepared to use more 
cocain while the surgeon is at work. Inflamed eyes absorb 
cocain more slowly, and in such cases more time should be 5 
allowed for anesthesia. If a few drops of an adrenalin 
solution (1 : 4000) be dropped into the eye the cocain will 
act more effectively. 

Cocain increases the effect of mydriatics, first, because 
it enhances absorption; second, because it provokes a con- 10 
traction of the vessels of the iris; third, because it acts 
directly upon the dilating fibers of the iris and the ciliary 
muscle itself. It should not be used continuously for days, 
as it interferes with the nutrition of the cornea, producing 
dryness and sometimes suppuration. As has been said, 15 
great care should also be taken in using solutions of bichlorid 
of mercury stronger than 1 : 10,000 in eyes which have been 
cocainized, as the eroded condition of the cornea which is 
sometimes produced by the cocain affords a favorable 
ground for the deposition of the bichlorid salt. This may 20 
be prevented if the surface of the cornea is occasionally 
moistened with a boric acid solution. In some patients 
medicines which are instilled into the eye pass so rapidly 
through the lacrimal duct into the nose and throat that it is 
well to tell all patients upon whom cocain is used that if it 25 
makes their mouth taste bitter to spit it out. Cocainism 
seldom occurs from use of the drug in the eye, but once in 
a great while some patient who is particularly susceptible to 



106 THE OPHTHALMIC NURSE 

its influence may manifest toxic symptoms, such as dizzi- 
ness, cold sweat, faintness, feeble and irregular pulse, etc. 
Under such circumstances the first thing to do is to have 
the patient lie down and administer whisky, morphin, 

5 strychnin or strong coffee, or allow him to inhale nitrite of 
amyl. 

Collodion consists of 3 parts of gun-cotton dissolved in 
75 parts of ether and 25 parts of alcohol. It forms a neat 
protective dressing for small non-infected wounds about the 

io eyelids and brow, and for the contracting effect in some 
cases of ectropion. The ether and alcohol evaporates and 
leaves the surface covered with a thin film. Combined 
with cantharides it is used for its blistering or counter- 
irritant effects. 

15 Copper sulphate (blue stone) is an antiseptic, styptic, and 
irritant which is freely dissolved in water (blue vitriol). It is 
an old-time remedy for chronic trachoma with scant \ 
cretions, but it has fallen somewhat into disuse on account 
of the severe irritation following its application. The pure 

20 crystal is usually applied to the everted lids, and if pre- 
ceded by the use of a local anesthetic and followed by the 
instillation of a few drops of glycerin or castor oil the pain 
will be much lessened. Sometimes used in solution (\ to 
J per cent.) as an irrigation in conjunctival affections with 

25 scanty secretions. 

Croton oil (oleum tiglii), a counterirritant, is a fixed oil 
expressed from the seed of croton tiglium, an East India 
tree. 



CONSIDERATION OF OPHTHALMIC REMEDIES 107 

Cyanid of Mercury. — See Mercury Cyanid. 

Dionin, made by the action of ethyl iodid upon morphin, 
exerts upon the eye a vasodilator action such as is possessed 
by no other agent known. It is not only a powerful anal- 
gesic, but it has a favorable action upon the morbid process 
within the eye; thus it hastens the resolution of pupillary 
exudations and the absorption of corneal infiltration. It 
increases the flow of lymph, lessens the tension in glaucoma, 
and aids in the absorption of other remedies, such as atropin 




Fig. 53. — The author's puncta clamp. 

and eserin, being of special value in the treatment of dis- 10 
eases of the iris, ciliary body, and sclera. 

It has a favorable influence on the healing process after 
operations and injuries, and the relief given to pain in most 
cases is prompt and complete. 

It may be regarded as doing good so long as its instillation 15 
in the eye is followed by a smarting sensation and redness 
or edema of the conjunctiva, and the greater the edema, the 
more decided is the analgesic action of the agent. 

For this reason it is advisable to begin with the weaker 
solutions and gradually increase the strength, and as the 20 



108 THE OPHTHALMIC NURSE 

reaction wears off use it less frequently. It can be used in 
solutions of from 1 to 10 per cent., and in some cases of 
iritis with adhesions equal parts of pure dionin and atropin 
are dropped into the lower culdesac after first applying a 

5 clamp on the puncta (Fig. 53) to prevent it from running 
into the tear duct. 

When prescribing dionin for patients to use at home they 
should be told of the reaction which follows its use, else they 
might discontinue it through fear of its doing them harm. 

10 Dioxogen. — See Per ox id of Hydrogen. 

Duboisin, the active principle of the plant Duboisea 
myoporoidea, is a mydriatic similar in its action to that of 
atropin, but more prompt and less lasting. It is used in 
from \ to 1 per cent, solutions, and its effects usually wear 

15 off in from four to six days. It is useful with patients who 

show idiosyncrasies to atropin, but, unfortunately, has 

marked toxic properties, which tend to limit its employment 

Ephedrin. — A mydriatic. A 2 per cent, solution dropped 

into the eye will be followed by complete mydriasis in about 

20 fifty minutes and will last for ten or twelve hours. It has 
little or no action on the accommodation or tension. 

Eserin sulphate (physostigmin), the alkaloid of calabar 
bean, is a yellowish powder which dissolves sparingly in 
water. Commercially it comes in 3- and 5-grain phials, 

25 which are tightly sealed. When once exposed to the air 
it deliquesces very rapidly, therefore in rilling a prescrip- 
tion, if the whole contents of the phial are not used, it is 
best to make a solution of that which remains, as it will 



CONSIDERATION OF OPHTHALMIC REMEDIES 109 

keep longer in solution. An excellent way to keep it is to 
mix it with ten times its weight of boric acid. A freshly 
made solution should always be the color of water, but with 
age and exposure to light it turns pink, and finally a deep 
red. If kept in a tightly corked blue or amber bottle it 5 
will retain its proper color longer. The change in color 
does not materially alter its effect upon the tissues of the 
eye other than making it more liable to irritate the con 
junctiva. In ophthalmology eserin is usually employed in 
solutions of from f to 1 grain to the ounce. When intro- 10 
duced into the eye it causes a contraction of the pupil, 
which begins in about fifteen minutes and lasts from four 
to eight hours. It is, therefore, valuable in diminishing 
intra-ocular tension in glaucoma and in preventing pro- 
lapse of the iris after corneal wounds. Its effect on the 15 
eye is increased when used with cocain on account of the 
contraction of the ciliary vessels produced by the latter. 
If its use causes headache, pilocarpin should be substituted. 

Eucain, another local anesthetic, is less toxic than cocain, 
and, like holocain, does not effect the eye in any way than 20 
to render it anesthetic. It acts nicely upon inflamed eyes, 
but has rather gone into disfavor on account of the violent 
burning which it causes. 

Euphthalmia hydrochlorate is a preparation which is used 
to dilate the pupil for diagnostic purposes solely, as it has 25 
little or no effect upon the accommodation. It is gen- 
erally used in a 5 per cent, solution and is very rapid in its 
effects, the pupil reaching its maximum dilation in an hour 



HO THE OPHTHALMIC NURSE 

and recovering therefrom within fifteen to twenty hours. 
It does not affect intra-ocular tension or irritate the con- 
junctiva, and is, therefore, especially useful to dilate the pu- 
pil before cataract extraction. 

5 Fluorescein is obtained by fusing 7 parts of resorcin and 
5 parts of phthalic anhydrid. It makes a yellowish-green 
solution and is used for diagnostic purposes only. 

Eight grains to the ounce of water is the strength of the 
solution most generally employed, and when dropped into 

io the eye and afterward washed out with a boric acid solu- 
tion it leaves any part of the cornea which is denuded of 
its epithelium stained a bright green. For this reason it is 
valuable in showing the exact extent of corneal ulceration and 
in locating minute foreign bodies in the cornea. 

15 Formaldehyd, or formic aldehyd, is a gas obtained by the 
oxidation of methyl alcohol. Being readily absorbed by 
water, a solution has been prepared to which the term 
"formalin" has been given. The solution contains 40 per 
cent, of the formaldehyd. When allowed to stand this 

20 fluid gives off the vapor of formaldehyd. 

Formalin is a powerful antiseptic, irritant, astringent, 
and disinfectant. It is sometimes used for irrigating the 
eye during operations, and in suppurative conditions of the 
conjunctiva in solutions of 1 : 3000 to 1 : 10,000, but is so 

25 irritating to the mucous membranes that it is seldom used. 
A solution 1 : 10 is frequently used for the sterilization of 
cutting instruments and for the preservation of pathologic 
specimens. The instruments should - not be allowed to 



CONSIDERATION OF OPHTHALMIC REMEDIES ni 

remain in formalin solution over five minutes, and then 
should be dipped in alcohol and sterile water before using. 

Glycerin, which is obtained as a by-product in the manu- 
facture of soap, is very hygroscopic and mixes in all pro- 
portions with water and alcohol. When applied to the 5 
conjunctiva it acts as a mild stimulant, antiseptic, and pro- 
tective. Having an affinity for water, it absorbs the latter 
from the mucous membrane and excites secretion, and when 
added to a nitrate of silver solution it increases the pene- 
trating power of the latter drug and makes it less painful. 10 
It is frequently combined with solutions of other medicines, 
such as tannic acid and boric acid, to prolong their action, 
as it coats the conjunctival and corneal surface, and is not 
as easily washed away by the tears as is a plain aqueous 
solution. 15 

Gum Acacia. — See Acacia. 

Holocain, a derivative of phenacetin, is a local anesthetic. 
It is sparingly soluble in water and is stable in solution not 
stronger than 2 per cent. Stronger solutions will pre- 
cipitate fine crystals. Holocain is so easily decomposed "by 20 
alkalies that if mixed with ordinary drinking-water or in 
glass vessels it becomes cloudy. In order to avoid this it 
is necessary to use distilled water, and to either mix it in a 
porcelain vessel or first boil the glass vessel in a solution of 
hydrochloric acid. Boiling does not interfere with its 25 
activity, although boiling is not necessary, as holocain is in 
itself a powerful antiseptic. It is a more powerful local 
anesthetic and is more rapid and more lasting in its effects 



112 THE OPHTHALMIC NURSE 

than cocain. Anesthesia is complete within fifteen seconds 
after the instillation of a 1 per cent, solution and lasts from 
fifteen to twenty minutes. It more thoroughly anesthetizes 
inflamed surfaces and the deeper structures of the eye than 

5 does cocain. Its great advantage in ophthalmology over 
the latter drug, however, is that it has no other effect upon 
the eye than to render it anesthetic. Unlike cocain, it does 
not contract the capillary blood-vessels, dilate the pupil, 
paralyze the accommodation, unfavorably effect the cor- 

io nea, or increase the intra-ocular pressure. For the latter 
reason it is especially advantageous in operations for glau- 
coma and for the removal of foreign bodies from the cornea. 
Homatropin hydrobromate, another alkaloid of bella- 
donna, also dilates the pupil and paralyzes the accommoda- 

15 tion, but its effects, while more rapid, are not as lasting 
as those of atropin. usually passing off in from twelve to 
twenty-four hours. For this reason it is used principally for 
diagnostic purposes to render more easy an ophthalmoscopic 
examination or the determination of the refraction. It is 

20 much increased in its action by the addition of cocain. 

Hydrogen peroxid (dioxygen, perhydrol) is a strong anti- 
septic and disinfectant which comes commercial ly in a 3 
per cent, solution. It has powerful bleaching, disinfecting, 
and oxidizing properties, and on account of its chemical 

25 action upon pus it is especially valuable in suppurative con- 
ditions of the eye, such as purulent conjunctivitis, lacrimal 
abscesses, and corneal ulcers, also in the treatment of 
wounds of the lids. A 25 per cent, solution may be instilled 



CONSIDERATION OF OPHTHALMIC REMEDIES 113 

into the eye four or five times a day, but should be carefully 
washed out immediately afterward with sterile water. Being 
of an unstable nature and decomposing readily into oxygen 
and water, it should be kept in a cool place. 

Hyoscin, another alkaloid of hyoscyamus, is a mydriatic 5 
five times as powerful as the sulphate of atropin, but it does 
not increase the intra-ocular tension as much or as readily 
irritate the mucous membranes, and is, therefore, indicated 
in persons exhibiting an idiosyncrasy for the latter drug. 
One drop of a 1 per cent, solution relieves the ciliary spasm 10 
sufficiently in one hour to make a refractive examination, 
and the accommodation recovers in three days. 

Hyoscyamin, derived from the plant Hyoscyamus niger, 
is a powerful mydriatic, dilating the pupil ad maximum in 
ten minutes, and paralyzing the accommodation in two 15 
hours after its instillation. The pupil does not return to 
the normal in less than eight or ten days. It is used when 
a prolonged rest of the accommodative muscle is desired in 
solutions of from 2 to 4 grains to the ounce of distilled 
water. It is decomposed by light and moisture, and should, 20 
therefore, be kept in colored bottles with glass stoppers. 

Iodin tincture, obtained from the ashes of sea-weed, is 
sometimes painted on the temple or forehead as a mild 
counterirritant or applied to corneal ulcers as a caustic. In 
using it great care should be taken not to get any of it in 25 
parts of the eye where it is not required. It is sometimes 
applied to the skin of the ocular region to prevent the ex- 
tension of an erysipelas. 



114 THE OPHTHALMIC NURSE 

Iodoform, made by heating together iodin, potassium car- 
bonate, alcohol, and water, is not a powerful antiseptic, but 
its ability to check secretion is well known. On mucous 
membranes it has a slight local anesthetic effect. It is 

5 sometimes dusted over corneal ulcers and into sockets from 
which the eye has been removed. It is valuable as an oint- 
ment in the proportion of 1 to 10 or 20, and dissolved in 
collodion it makes an excellent dressing for wounds of the 
ocular region. It is little used on account of its disagreeable, 

io penetrating odor. When used on raw surfaces it is some- 
times absorbed and produces visual disturbances closely 
akin to those of tobacco. 

Itrol (silver citrate) is made by precipitating a solution 
of silver nitrate by means of citric acid and sodium bicar- 

15 bonate. It is used as a powder for dusting wounds of the 
conjunctiva, etc. 

Lead acetate (sugar of lead) is frequently used in solution 
or in the form of the so-called "lead-and-opium wash" as a 
soothing application to inflamed and swollen lids. Care 

20 must be taken, however, not to use it in cases with abrasion 
of the cornea, as there is danger of the insoluble lead com- 
pounds being precipitated from the solution and causing 
white ineradicable incrustations on the cornea in such cases. 
Mercurial ointment (blue ointment) is a mixture of the 

25 oleate of mercury, metallic mercury, benzoated lard, and 
prepared suet containing about 50 per cent, of metallic 
mercury. It is the favorite mercurial mixture for inunc- 
tion in the treatment of ocular affections of specific origin. 



CONSIDERATION OF OPHTHALMIC REMEDIES 115 

Mercury Bichlorid (Corrosive Mercuric Chlorid, Corrosive 
Sublimate). — Solutions are used in the eye in strength va- 
rying from 1 : 5000 to 1 : 10,000. A stronger solution than 
1 : 5000 should never be used, as it would be too irritating 
to the eye and skin, and when a cocain solution is used at 5 
the same time not even a 1 : 5000 solution should be used, 
as the eroded condition of the cornea which is sometimes pro- 
duced by the cocain affords a favorable ground for the de- 
position of the bichlorid salt. A 1 : 500 solution is sometimes 
rubbed into the conjunctiva after operations for trachoma 10 
(granulated lids). Most hospitals keep a 1 : 1000 solution 
on hand and dilute it as required. The nurse should never 
guess at the dilution, but measure it out, for if too strong 
it may cause considerable irritation. Care should be taken 
not to make solutions for the eye of tablets containing 15 
ammonium chlorid, as the latter drug is irritating to the 
conjunctiva. It is put up in the form of an ointment known 
as White's Ointment, which is commonly employed after 
operations upon the eye. 

Mercury Chlorid, Mild. — See Calomel. 20 

Mercury cyanid in solutions of from 1 : 5000 to 1 : 20,000 
is sometimes injected beneath the bulbar conjunctiva in 
purulent infections of the eyeball, as ulcers of the cornea, 
keratitis, and infections following cataract operations. 

Mercury, yellow oxid, in ointment form, of from 4 to 12 25 
grains to the ounce of vaselin, is a favorite astringent and 
antiseptic in cases of blepharitis (inflammation of the lid 
margins with scales), and as an irritant and stimulant in 



Il6 THE OPHTHALMIC NURSE 

connection with massage for the treatment of corneal opac- 
ities, chronic keratitis, and pannus. It should be put up 
in amber-colored glass jars instead of opal ones, as this pre- 
vents the chemical action of light upon the mercury salt and 
5 preserves the ointment much longer. Unless thoroughly 
mixed it will irritate. 

Methyl Violet. — See Pyoctanin. 

Mustard (sinapis) is used in the form of a plaster as a 
counterirritant. 
10 Mydrin. — A mydriatic, a powder composed of 1 part of 
homatropin to 100 parts of ephedrin. It i> used as a myd- 
riatic mainly for ophthalmoscopic purposes. Its effects 
pass off very quickly. 

Nargol. — Nucleinate of silver. A silver compound with 

15 nucleinic acid derived from yeast, containing about 10 per 

cent, of metallic silver. It is non-irritating, it penetrates 

deeper than silver nitrate, and has an action similar to that 

of argyrol and protargol. 

It is commonly used as a stimulant in slow-healing cor- 
20 neal ulcers, and in the chronic form of blepharitis. 

Nitrate of Silver. — See Silver X Urate. 

Nitrite of Amyl. — See . 1 myl Nitrite. 

Novocain. — An organic compound much le^s toxic than 
cocain and is, therefore, especially useful for hypodermic 
25 injection. For this purpose it is generally mixed with 
adrenalin chlorid in solution of from 1 to 10 per cent. Its 
anesthetic effect is comparatively brief and it does not 
effect the pupil, the accommodation, or the tension of the eye. 



CONSIDERATION OF OPHTHALMIC REMEDIES 117 

Nucleate of Silver. — See Nargol. 

Oleum Ricini. — See Castor Oil. 

Oleum Tiglii. — See Croton Oil. 

Olive Oil (Sweet Oil). — An emollient. Sometimes used 
as a solvent for atropin, eserin, and other alkaloids, and also 5 
as an antidote in burns of the eye by lime and strong alkalies. 

Perhydrol. — See Peroxid of Hydrogen. 

Permanganate of Potash. — See Potassium Permanganate. 

Phenol. — See Carbolic Acid. 

Physostigmin. — See Eserin. 10 

Pilocarpin hydrobromate, the alkaloid of jaborandi, is a 
myotic, milder in its effect on the eye than eserin, being 
non-irritating and devoid of any tendency to produce head- 
ache, ciliary congestion, or iritis, and it is generally used in 
solutions of twice the strength, from \ to 2 grains. It is 15 
sometimes added to cocain solutions, as it will counteract 
the tendency of the latter drops to dilate the pupil and 
paralyze the accommodation, without interfering with its 
anesthetic action. It is given hypodermically in doses of 
from xo to -J gr. to produce sweating for the absorption of 20 
exudates in deep-seated eye troubles. Solutions of pilo- 
carpin keep better than do solutions of eserin. 

Plumbi Acetate. — See Lead Acetate. 

Potassium permanganate in solutions of \ to 1 per cent, 
is a very efficient wash in purulent eye cases, but has rather 25 
fallen into disuse on account of its staining properties. It 
is also used as a spray in the nose preliminary to cataract 
operations. 



u8 THE OPHTHALMIC NURSE 

Protargol, a combination of alum and silver, containing 
about 8 per cent, of the latter drug, is a valuable astringent 
in eye work, being usually prescribed in solutions of from 
5 to 25 per cent. Like argyrol, it is less irritating than the 
5 silver nitrate and is used in all forms of discharging con- 
junctivitis. 

Pyoctanin, methyl-violet, is a pus destroyer. It pene- 
trates tissues and acts upon deeply embedded pathogenic 
micro-organisms and does not coagulate albumin, 
io Pyoctanin yellow is sometimes applied directly to the 
lids in trachoma and to the ulcerated cornea. 

Rose-water is somewhat astringent and is used as an 
agreeable flavoring agent and vehicle for eye lotions. 

Scopolamin hydrobromate, identical with hvoscin, is a 

15 mydriatic which is much more powerful than atropin, but 

has less effect upon the intra-ocular tension, therefore it is 

useful in cases where the latter drug fails to dilate the 

pupil. 

Silver Citrate. — See Itrol. 
20 Silver Lactate. — See ActoJ. 

Silver nitrate, the oldest and most valuable astringent used 
in ophthalmology, is the best local remedy for almost all 
secretory affections of the conjunctiva, and has a strong 
antiseptic action on certain germs, especially the gonococ- 
25 cus. It is generally used in solutions of from 1 to 3 per 
cent, and is of special value in acute contagious diseases of 
the eye. It is better to brush it over the conjunctiva of the 
everted lids, and if immediately neutralized with a normal 



CONSIDERATION OF OPHTHALMIC REMEDIES 119 

salt solution the pain and irritation following its use will 
be lessened. If used frequently and too long it will dis- 
color the conjunctiva, and for this reason should seldom 
be prescribed for home use. It is contraindicated in all 
cases where there is an ulceration or other lesion of the 5 
cornea, as it may produce a permanent opacity of that 
membrane by precipitation. Much exposure to light will 
change it into the black oxid of silver, therefore it should 
be kept in blue or amber bottles. Various substitutes for 
silver have been devised. None of them take the place of 10 
silver, but most of them are less irritating and less painful 
when applied, and some of them are of special value in 
ophthalmology. 

Silver Vitellin. — See Argyrol. 

Sinapis. — See Mustard. 15 

Sodium bicarbonate (saleratus) is frequently used in solu- 
tion, 1 to 3 per cent., with distilled water, for cleansing the 
cilia and edges of the lids of scales and dried secretions. 

Sodium borate (borax) is even a milder antiseptic than 
boric acid, and differs from it in that it is slightly alkaline. 20 
It is a good non-irritating cleansing solution, and is used 
in about the same strength as boric acid. Combined with 
the latter drug it renders it more soluble and adds to its 
effectiveness. 

Sodium Chlorid (Common Salt). — The so-called normal 25 
salt solution is valuable for neutralizing the silver nitrate 
after it has been applied to the palpebral conjunctiva. It 
is also used as an irrigating and cleansing solution before, 



120 THE OPHTHALMIC NURSE 

during, and after operations on the eye, and especially for 
flushing out the anterior chamber after cataract operations. 

Sulphate of Alum. — See Alum Sulphate. 

Sulphate of Atropin. — See A tropin Sulphate. 
5 Sulphate of Copper. — See Copper Sulphate. 

Sulphate of Eserin. — See Eserin Sulphate. 

Sulphate of Zinc. — See Zinc Sulphate. 

Suprarenal Extract. — Sec Adrenalin Chlorid. 

Tannic Acid (Tannin).— Owing to its affinity for albumin, 
10 it has a powerful astringent action. It therefore contracts 
and toughens swollen and relaxed mucous membranes, and 
is frequently used in inflammatory conditions of the con- 
junctiva. It is especially effective when mixed with glyc- 
erin and camphor-water. The usual strength used is from 
15 2 to 10 per cent. 

Tannin. — See Tannic Arid. 

Tincture of Iodin.^— See Iodin Tincture. 

Vaselin is used as a vehicle for many eye ointments and 
for anointing the lids before the application of hot or cold 
20 packs. 

Yellow Oxid of Mercury.— See Mercury, Yellow Oxid. 

Zinc sulphate, in solutions of from -] to 1 per cent., is often 

used in the eye when astringents are indicated. It is similar 

in its effects to copper sulphate, but is somewhat less ir- 

25 ritating, and is indicated in most forms of conjunctivitis 

especially the form familiarly known as "pink-eye." 



SYNOPSIS OF PRECEDING TEXT MATTER 



Chapter II. Anatomy of the Eye 



Orbit-shape, composed of what bones?/^^^^^^ 056 ' 



-purpose. 



Eyeball — 
size, 
shape. 



Tunics- 



f Cornea — description; nutrition. 
First. . -j Sclera — description; attachments; perfora- 
tions. 



Second 



Iris — description; function; pigment; mus- 
cular system. 

Ciliary body — description; accommoda- 
tion. 

Choroid — description; function. 



TV H /R^ina — description; macula 
r \ Op tic nerve — description; fu: 



function. 



{Aqueous — description; amount; how pro- 
duced; anterior and posterior chambers. 
Vitreous — hyaloid membrane; description; 
location; function; nutrition. 



Pupil — description; function; size. 

fSuperior rectus, inferior rectus, external 

Fyfernal ornlar musHe* J rectus, internal rectus. 

External ocular muscles Superior ob liq U e, inferior oblique— origin; 

insertion, and function of each. 



Eyebrows — description; function. 



Appendages 



Lids 



Lacrimal 
apparatus 



Cartilage — description; function. 
Conjunctiva, palpebral and ocular — de- 
scription; function. 
Cilia — description; function. 
Meibomian glands — description; function. 

{Gland — description; function. 
Punctae — description; function. 
Sac — description; function. 
Duct — description; function. 



122 



THE OPHTHALMIC NURSE 



Chapter III. Physiology of the Eye 



Physiology 



Refraction. 



Likeness 
of eye to 
a camera. 



Normal refraction— description. 

Near-sightedness — description ; correction ; 
cause; result of neglect. 

Far-sightedness — description; correction. 

Astigmatism, six kinds — description; cor- 
rection. 

Presbyopia, old sight — description; correc- 
tion; cause. 

Sclerotic = box. 

Iris = shutter. 

Retina = sensitive plate. 

Crystalline lens = lens. 

Accommodation = adjustment. 



Hygiene 



Chapter IV. Hygiene of the Eye 



Infants. 



Children. 



Adults 



Proper cleansing of maternal passages and 

of baby's i 
Ophthalmia neonatorum — prophylaxis. 
Exposure to light — precautions. 
Objects held dose to eyes. 
Teething, convulsions. 

{ Kindergarten. 
School — books, hours of work. 
Strabismus — cause. 

{Reading while convalescing from illness. 
Reading while in motion. 
Reading while lying down. 
Reading in poor light. 



Eye drops 



Chapter V. Practical Ophthalmic Xirsixg 

'For cleansing — how instilled. 

Poisonous — how instilled. 

Children — how managed; what precautions. 

The pipet, sterile — how held; when used for mydriatic; 
when used in contagious diseases. 

Atropism. 
Eversion of lids, lower and upper — how accomplished. 
Ointment — how applied; massage. 
Powders — how applied. 
Poultices — never used. 

Massage — how applied; when indicated; when contraindicated. 
Blisters — where and how applied; for what purpose. 

{Hot — dry and moist; action; indica- 
C^-^nfa^ationsihowappHed; 
in traumatism; precaution. 



SYNOPSIS OF PRECEDING TEXT MATTER 123 

Leeching — where and how applied; indications; best kind; how tested; 

how removed; best way of leeching. 
Rest — sleep; narcotics; darkness; bandages; mydriatics; for convales- 
cents. 
Sweating — when indicated; when contraindicated; how obtained. 
Inunctions — what preparations of mercury; where applied; how applied; 
when stopped; protection of nurse. 

,'How treated; isolation; precaution; protection 
of good eye. 
Contagious eye diseases ^Buller's shield — how made. 

j Ophthalmia neonatorum — cause; prophylaxis, 
[ and treatment. 

Chapter VI. Preparation for Operation 

Responsibilities of the nurse; observe abnormalities of patient; prepa- 
ration of operating room; preparation of patient; preparation of solu- 
tions; preparation of instruments; preparation of dressings; prepara- 
tion of beds. 

Chapter VII. In the Operating Room 

Duties upon entrance of patient; knowledge of technic of operation; 
the instruments; the dressings; bandages; removal of patient from 
operating room; pathologic specimens. 

Chapter YIII. Postoperative Nursing 

After general anesthesia; care of room; temperature; shock; sneezing; 
vomiting; cathartics; preparation for surgeon's call; contents of eye tray. 

Chapter IX. Classification of Ophthalmic Remedies 

Local anesthetics; analgesics; antiseptics; astringents; caustics; 
counterirritants; emollients; irritants; lymphagogues; mydriatics; my- 
otics; refrigerants; staining agents; stimulants; styptics; vasoconstrictors; 
vasodilators. 

Chapter X. Consideration of Ophthalmic Remedies 

Acacia, acetic acid, acoin, actol, adrenalin chlorid, adrin, alum sul- 
phate, alypin, amyl nitrite, argoin, argyrol, aristol, atropin, boric acid, 
calomel, camphor, cantharides, carbolic acid, castor oil, cherry laurel 
water, chlorin-water, cocain, collodion, copper sulphate, croton oil, 
dionin, duboisin, ephedrin, eserin, eucain, euphthalmin, fluorescein, for- 
malin, glycerin, holocain, homatropin, hydrogen peroxid, hyoscin, hyos- 
cyamin, iodin tincture, iodoform, itrol, lead acetate, mercury bichlorid, 
mercury cyanid, mercury yellow oxid. mustard, mydriasin, nargol, novo- 
cain, olive oil, pilocarpin, potassium permanganate, protargol, pyoctanin, 
rose-water, scopolamin, silver nitrate, sodium bicarbonate, sodium borate, 
sodium chlorid, tannic acid, vaselin, zinc sulphate. 



OPHTHALMIC INSTRUMENTS 

If you wish to become an ophthalmic nurse of ability 
you will not only become acquainted with the preparation 

and postoperative care of patients, but you will familiarize 
yourself with the technic of the different operations and 
with the various instruments used in ophthalmic surgery, 
learning their names and uses, so that when assisting in an 
operation you may anticipate the needs of the surgeon and 
have each instrument ready to hand to him almost before he 
asks for it. 

The following are illustrations of the most commonly 
used ophthalmic instruments: 

Plate I 

No. 1. Straight probe-pointed tenotomy scissors. 

No. 2. Curved probe-pointed tenotomy scissors. Used for 
cutting the conjunctiva and muscles in all opera- 
tions on the external ocular muscles and in re- 
moval of eyeball. 

No. 3. Iris scissors. Used in cutting the iris in performing 
an iridectomy. 

No. 4. Stevens' tenotomy scissors. (Use same as N 
and 2.) 

No. 5. Enucleation scissors. For cutting the optic nerve 

in removal of eyeball. 
124 



OPHTHALMIC INSTRUMENTS 



125 



No. 6. Chalazion clamp. To clamp on a chalazion before 
operation on same, in order to check the hemor- 
rhage. 

Plate I 




No. 7. Ectropion forceps. To clamp on the lid in doing 
operations for ectropion. 



126 THE OPHTHALMIC NURSE 

No. 8. Iris forceps. For drawing the iris out through the 
corneal wound in doing an iridectomy. 

No. 9. Cilia forceps. For extracting wild hairs from the 
lid margin. 

No. 10. Advancement forceps. For holding the cut end of 
an external ocular muscle during the operation of 
advancement. 

No. 11. Capsule forceps. For grasping the lens capsule in 
cataract operations when the lens is extracted en 
capsule. 

No. 12. Fixation forceps. For holding the eyeball steady in 
all operations when it is to be operated on. 

No. 13. Trachoma roller forceps. For rolling out the 
granulations from the conjunctiva in trachoma. 

No. 14. Trachoma forceps. For squeezing out the granula- 
tions from the conjunctiva in trachoma. 

Plate II 
No. 15. Cataract knives. For making the corneal incision 

in cataract operations. 
No. 16. Scalpel. For making the initial incision in many 

operations on the lids. 
No. 17. Curved bistoury. For lancing abscesses, boils, etc., 

in the region of the eye. 
No. 18. Beers' knife. For incising the cornea. Used by 

some operators in the place of a cataract knife. 
No. 19. Keratome. For incising the cornea in performing 

an iridectomy. 



OPHTHALMIC INSTRUMENTS 



127 



No. 20. Canaliculus knife. For slitting or enlarging the 
puncta preparatory to probing same. 



Plate II 




No. 21. Needle knifes. For needling or breaking up the 
lens in soft cataract or an opaque capsule several 
weeks or longer after the extraction of a cataract. 



128 THE OPHTHALMIC NURSE 

No. 22. Paracentesis knife. For tapping the anterior 
chamber (making an incision through the cornea 
into the anterior chamber for the purpose of 
letting the aqueous escape when the tension of 
the eye is above par). 

No. 23. Blunt bistoury. For enlarging an incision which 
has been made by some other knife. 

No. 24. Lacrimal dilator. For dilating or stretching the 
puncta and lacrimal duct. 

No. 25. Lacrimal probes. For dilating or stretching the 
lacrimal duct, thus breaking up and destroying 
strictures of same. 

No. 26. Lacrimal syringe. For injecting fluids through the 
lacrimal sac and duct. 

No. 27. Chalazion scoop. For scooping out the contents of 
a chalazion (small tumor of eyelid formed by dis- 
tention of a Meibomian gland with secretion). 

No. 28. Lens scoop. For extracting the lens which does not 
come out by the usual method during a cataract 
operation. 

No. 29. Enucleation spoon. For engaging and holding the 
optic nerve preparatory to cutting same in re- 
moval of the eyeball. 

No. 30. Foreign body spuds. For removing foreign bodies 
which are embedded in the cornea. 

No. 31. Strabismus hook. For engaging and drawing for- 
ward the external ocular muscles during opera- 
tions on same. 



OPHTHALMIC INSTRUMENTS 129 

No. 32. Artificial leech. For extracting blood from the 

temple. 
No. 33. Aluminum shield. For protecting the eye against 

blows, etc., after operations on the eyeball. 

Plate III 

No. 34. Eye speculum. For holding the lids apart during 
most operations on the eyeball. 

No. 35. Lid retractor. For holding the upper lid up and 
away from the eyeball during many operations 
on the latter. 

No. 36. Needle-holder (as name implies). 

No. 37. Spatula. For exerting pressure on the eyeball dur- 
ing extraction of the lens and for removing small 
particles of lens substance after cataract extrac- 
tion. 

No. 38. Tattoo needle. For tattooing India-ink on the 
opaque cornea of a blind eye for the purpose of 
making it appear less conspicuous. 

No. 39. Trachoma file. For filing or rubbing out the granu- 
lations of a trachomatous lid. 

No. 40. Strabismometer. For measuring the degree of de- 
viation in a case of strabismus. 

No. 41. Cystotome. For cutting the lens capsule prepara- 
tory to extraction of the lens in cataract opera- 
tions. 

No. 42. Magnet. For extracting particles of steel or iron 
from the eye. 



i3o 



THE OPHTHALMIC NURSE 



No. 43. Silk suture. Used in stitching up most wounds 
after injuries to or operations upon the eye. 



Plate III 




#£ 



No. 44. Needles. 

No. 45. Electrodes. For cauteriznig corneal ulcers with the 
galvanocautery. 



OPHTHALMIC INSTRUMENTS 131 

No. 46. Test-drum. For testing the points and edges of 
eye-cutting instruments. 

No. 47. Puncta clamp. For closing the puncta when poison- 
ous solutions are used in the eye, so that they will 
not flow through the tear duct into the nose. 

No. 48. Ophthalmoscope. For examining the media within 
the eye. With this simple instrument can be 
seen the optic nerve head, the retina, choroid, 
vitreous, and lens. 

No. 49. Soft-rubber bulb syringe. For flushing the eye 
with cleansing solutions. 



A LIST OF SOME OF THE MOST COMMONLY PER- 
FORMED OPERATIONS ON THE EYES, GIVING 
PURPOSE OF SAME AND THE INSTRUMENTS 
REQUIRED 

OPERATIONS UPON THE CORNEA 

Paracentesis of the Cornea. — For the purpose of allowing 
an escape of the aqueous humor, thereby temporarily re- 
ducing the intra-ocular tension. 

Instruments. — Speculum (34), fixation forceps (12), para- 
centesis knife (22). 

Saemisch's section is performed in those cases in which 
there exists a large sloughing ulcer of the cornea which is 
rapidly progressing, the corneal tissue itself being infil- 
trated with pus and accompanied by the condition known 
as hypopyon (pus in the anterior chamber). 

Instruments. — Speculum (34), lid retractor (35), fixation 
forceps (12), cataract knife (15). 

Tattooing the Cornea. — This operation is done for cos- 
metic purposes, when there is a dense white opacity of one 
eye in or near the center of the cornea. It can be tattooed 
with India-ink so as to resemble at a short distance the 
black pupil of the opposite eye, thus rendering the appear- 
ance of the patient more agreeable. 

Instruments. — Speculum (34), fixation forceps (12), India- 
ink and tattoo needles (38). 
132 



LID OPERATIONS 133 

OPERATIONS UPON THE EXTERNAL OCULAR MUSCLES 

Tenotomy (Partial or Complete). — For the purpose of 
lessening the strength of any particular one of the external 
ocular muscles in order to make it more nearly in the right 
proportional strength to its opponent. 

Instruments. — Speculum (34), small toothed forceps (11), 
tenotomy scissors (2), strabismus hooks (31), needles (44), 
needle-holder (36), silk suture (43). 

Advancement. — Performed for the purpose of increasing 
the strength of any particular one of the external ocular 
muscles in order to make it nearer the right proportional 
strength to its opponent. 

Instruments. — Speculum (34), fixation forceps (12), iris 
forceps (8), tenotomy scissors (4), strabismus hooks (31), 
advancement forceps (10), needles (44), silk sutures (43), 
needle-holder (36). 

Shortening of the external ocular muscles consists of tak- 
ing a loop in a muscle or removing a piece, afterward sutur- 
ing the ends together, in order to reduce the length and 
thereby increasing its strength. 

Instruments. — Speculum (34), fine-toothed forceps (11), 
tenotomy scissors (4), strabismus hooks (31), muscle tucker, 
needles (44), needle-holder (36), silk sutures (43). 

LID OPERATIONS 

Chalazion Operation. — For removal of a chalazion or 
cystic tumor of lids. 

Instruments. — Chalazion clamp (6), scalpel (16), chala- 



134 



THE OPHTHALMIC NURSE 



zion spoon (27), lacrimal syringe (26), needles (44), needle- 
holder (36), silk suture (43). 

Ectropion Operation. — For the correction of ectropion or 
eversion of the lid margin. 

Instruments. — Ectropion forceps (7), scalpel (16), small 
toothed forceps (11), straight scissors (1), needles (44), nee- 
dle-holder (36), silk suture (43). 

Entropion Operation. — For the correction of entropion or 
inversion of the lids. 

Instruments. — Scalpel (16), small toothed forceps (11), 
straight scissors (1), needles (44), needle-holder (36), silk 
suture (43). 



OPERATIONS UPON THE LENS AND LENS CAPSULE 

Cataract Extraction. — For the purpose of delivering the 
cataractous lens in toto. 

Instruments. — Speculum (34), fixation forceps (12), cata- 
ract knife (15), iris forceps (8), iris scissors (3), cystotome 
(41), spatula (37), lens scoop (28), capsule forceps (11). 

Needling Operation for Secondary Cataract. — When a hard 
cataract is extracted without the capsule, the latter is apt 
to become opaque later on and obstruct vision. The need- 
ling is done for the purpose of making an opening or pupil 
through this opaque capsule. 

Instruments. — Speculum (34), fixation forceps (12), knife 
needle (21). 

Discission of Cataract. — Performed in cases of soft cata- 
ract where it is desired to get rid of a cataractous lens by 



OPERATIONS UPON THE IRIS 135 

absorption. An opening is made in the anterior capsule of 
the lens, thus permitting the entrance of aqueous humor, 
which produces dissolution of the lens substance and is fol- 
lowed by its absorption. 

Instruments. — Speculum (34), fixation forceps (12), needle 
knives (21). 

OPERATIONS UPON THE SCLERA 

Anterior Sclerotomy. — Performed for the purpose of 
lessening the intra-ocular tension in glaucoma. 

Instruments. — Speculum (34), fixation forceps (12), cata- 
ract knife (15). 

Posterior Sclerotomy. — Performed in cases of detached 
retina and as a preliminary operation to iridectomy in cases 
of glaucoma. 

Instruments. — Speculum (34), fixation forceps (12), cata- 
ract knife (15). 

OPERATIONS UPON THE IRIS 

Iridectomy consists of removing a V-shaped piece of the 
iris. It is performed for many purposes, among which are 
the relief of intra-ocular tension (glaucoma); the improve- 
ment of vision where there is a large central opacity of the 
cornea and as a preliminary to the operation for the extrac- 
tion of cataract. 

Instruments. — Speculum (34), fixation forceps (12), kera- 
tome (19), cataract knife (15), iris forceps (8), iris scissors 
(3), spatula (37). 



136 THE OPHTHALMIC NURSE 

Iridotomy is usually performed for the purpose of making 
an artificial pupil, when the pupil has been closed by severe 
inflammation or exudation. A slit is made in the iris in such 
a manner that the contraction of the fibers of the mem- 
brane on either side of the slit will make an opening through 
which the patient can see. 

Instruments. — Speculum (34), fixation forceps (12), kera- 
tome (19), DeWecker scissors. 

OPERATION UPON THE EYEBALL 
Enucleation of the Eyeball. 

Instruments. — Speculum (34), small toothed forceps (11), 
tenotomy scissors (4), strabimus hook (31), enucleation 
spoon (29), enucleation scissors (51). 



GLOSSARY ■ 

Abrasion. — i. A rubbing or scraping off. 2. A spot rubbed 
bare of skin or mucous membrane. 

Adipose. — Of a fatty nature; fatty; fat. 

Albinism. — Abnormal, but not pathologic, whiteness of the 
skin, hair, and eyes: achromoderma. This condition is often 
attended with astigmatism, photophobia, and nystagmus. 

Albino. — A person affected with albinism. 

Albumin. — A simple protein found in nearly even* animal 
and in many vegetable tissues, and characterized by being 
soluble in water and coagulable by heat. It contains carbon, 
hydrogen, nitrogen, oxygen, and sulphur. 

Alkali. — Any one of a class of compounds which form salts 
with acids and soaps with the fats. 

Alkaloid. — Any alkaline or basic principle of vegetable ori- 
gin. The alkaloids are nearly all unsaturated ammonia com- 
pounds or amins, and act like ammonia in combining with 
acids to form crystalline salts. 

Amblyopia. — Dimness of vision from imperfect sensation 
of the retina and without organic lesion of the eye. 

Anemia, Anaemia. — A condition in which the blood is de- 
ficient either in quantity {oligemia) or in quality. The de- 
ficiency in quality may consist in diminution of the amount of 

1 The definitions given in this Glossary are taken from Dorland's 
American Illustrated Medical Dictionary. 

*37 



138 THE OPHTHALMIC NURSE 

hemoglobin (oligochromemia) or in diminution of the number 
of red blood-corpuscles (oligocythemia). 

Anesthesia, Anaesthesia. — Loss of feeling or sensation, es- 
pecially loss of tactile sensibility, though the term is used for 
loss of any of the other senses. 

Anesthetic. — 1. Without the sense of touch or of pain. 2. 
A drug that produces anesthesia. 

Anesthetist. — An expert in administering anesthetics. 

Anodyne. — Relieving pain. A medicine that relieves pain. 
The anodynes include opium, morphin, codein, hyoscin, 
atropin, coniin, ether, lupulin, potassium bromid. 

Anomaly. — Marked deviation from the normal standard. 

Antidote. — A remedy for counteracting a poison. 

Antiseptic. — Preventing decay or putrefaction. A sub- 
stance destructive to poisonous germs. Some of the chief 
antiseptics are alcohol, boric acid, phenol, creosote, corrosive 
sublimate, common salt, charcoal, chlorin, tannic acid, sugar, 
and vinegar. 

Appendage. — Any thing or part appended. 

Aqueous. — Watery; prepared with water. 

Asepsis. — Absence of septic matter, or freedom from in- 
fection. 

Assimilation. — The transformation of food into living 
tissue. 

Atrophy. — A wasting or diminution in the size of a part; 
defect or failure of nutrition. 

Atropinism, Atropism. — Poisoning due to the misuse of 
atropin or of belladonna. 



GLOSSARY 139 

Blepharitis. — Inflammation of the eyelids. 

Bulbar. — Pertaining to a bulb, particularly the eyeball. 

Canthus. — The angle at either end of the slit between the 
eyelids: the canthi are distinguished as an outer or temporal 
and inner or nasal. 

Centigrade. — Having one hundred degrees or grades. 

Centrifugal. — Moving away from a center; efferent or 
exodic. 

Centripetal. — Moving toward a center; esodic or afferent. 

Chalazion. — A small tumor of the eyelid, formed by the 
distention of a meibomian gland with secretion. 

Choroiditis. — Inflammation of the choroid coat of the eye. 

Cilia. — The eyelashes. 

Coagulation. — The process of changing into a clot or of 
being changed into a clot. 

Cocainism. — The morbid habit of mind and body caused by 
prolonged misuse of cocain as a stimulant or a narcotic. 

Coma. — Profound stupor occurring in the course of a disease 
or after severe injury. 

Conjunctivitis. — Inflammation of the conjunctiva. 

Culdesac. — A blind pouch or cecum; a cavity closed at 
one end. 

Cyclitis. — Inflammation of the ciliary body. 

Cycloplegia. — Paralysis of the ciliary muscle. 

Defecation. — The discharge of fecal matters from the 
bowel. 



t40 THE OPHTHALMIC NURSE 

Deliquescence. — The condition of becoming liquefied as a 
result of the absorption of water from the air. 

Delirium. — A mental disturbance marked by illusions, hal- 
lucinations, short unsystematized delusions, cerebral excite- 
ment, physical restlessness and incoherence, and having a 
comparatively short course. 

Diaphoresis. — Perspiration, and especially profuse per- 
spiration. 

Diplopia, Diplopy. — The seeing of single objects as double 
or two. 

Discission. — A cutting in twain, or division, as of a soft 
cataract. 

Ecchymosis. — An extravasation of blood; also a discolora- 
tion of the skin caused by the extravasation of blood. 

Ectropion, Ectropium. — Eversion or turning out of the 
edge, as of an eyelid. 

Eczematous. — Affected with or of the nature of eczema. 

Edema, (Edema. — Swelling due to effusion of watery liquid 
into the connective tissue. 

Enema.— A clyster or injection; a liquid thrown or to be 
thrown into the rectum. 

Enucleation.— The removal of a tumor or other body in 
such a way that it comes out clean and whole, like a nut from 
its shell. 

Epithelium. — The covering of the skin and mucous mem- 
branes, consisting wholly of cells of varying form and ar- 
rangement. 



GLOSSARY 141 

Erysipelas. — An acute febrile, somewhat contagious disease, 
believed to be due to the presence of Streptococcus erysipel- 
atis, and marked by chill, fever, and intense local redness of 
the skin and mucous membranes. 

Extra-ocular. — Outside of the eyeball. 

Flatulence. — Distention of the stomach or intestines with 
air or gases. 

Focus. — The point of convergence of light rays or of the 
waves of sound. 

Fomentation. — Treatment by warm and moist applications; 
also the substance thus applied. 

Fungate. — To grow rapidly like a fungus. 

Fungus. — A growth on the body resembling a fungus; a 
spongy mass of morbid granulation tissue. 

Galvanocautery. — Cautery by a wire heated with a galvanic 
current. 

Glaucoma. — A disease of the eye marked by intense intra- 
ocular pressure, resulting in hardness of the eye, atrophy of 
the optic disk, and blindness. 

Gonococcus. — A bacterial coccus, the specific organism of 
gonorrhea: the Micrococcus gonorrhoea. 

Hygroscopic. — Readily absorbing moisture. 
Hypermetropia, Hyperopia. — Far-sightedness. 
Hypopyon. — An accumulation of pus in the anterior cham- 
ber of the eye. 



142 THE OPHTHALMIC NURSE 

Idiosyncrasy. — A habit or quality of body or mind peculiar 
to any individual. 

Impregnation. — i. The act of fecundation or of rendering 
pregnant. 2. The process or act of saturation; a saturated 
condition. 

Incrustation. — The formation of a crust; a crust, scale, or 
scab. 

Indolent. — Causing little pain, as an indolent tumor. 

Inorganic. — 1. Having no organs. 2. Not of organic origin. 
3. Pertaining to substances not of organic origin. 

Instil. — To apply a remedy by drops. 

In toto. — As a whole; completely. 

Intra-ocular. — Situated within the eye. 

Inunction.— The act of anointing or of applying an oint- 
ment with friction. 

Iridectomy. — Surgical removal of a part of the iris by cut- 
ting. 

Iritis.— Inflammation of the iris. The condition is marked 
by pain, congestion in the ciliary region, photophobia, con- 
traction of the pupil, and discoloration of the iris. It is 
caused by injury, syphilis, rheumatism, gonorrhea, tubercu- 
losis, etc. 

Isolate.— To separate from other persons, materials, or 

objects. 

Keratitis. — Inflammation of the cornea. 

Lanolin.— Rectified wool-fat: used as an excipient for 
remedies for external use. 






GLOSSARY 143 

Lymph. — A transparent, slightly yellow liquid of alkaline 
reaction which fills the lymphatic vessels. It is occasionally 
of a light rose color from the presence of red blood-corpuscles, 
and is often opalescent from particles of fat. 

Micro-organism. — Any minute animal or plant. 

Milliampere. — One- thousandth part of an ampere. 

Monocular. — Pertaining to or having but one eye. 

Mucopurulent. — Containing both mucus and pus. 

Myopia. — Near-sightedness, or short sight; defective eye- 
sight due to too great refractive power of the eye, so that the 
rays coming from an object beyond a certain distance are 
focused in front of the retina. 

Narcotic. — 1. Producing sleep or stupor. 2. Any drug that 
produces sleep or stupor and at the same time relieves pain. 

Occiput. — The back part of the head. 

Palpebral. — Pertaining to an eyelid. 

Pannus. — An abnormal membrane-like vascularization of 
the cornea, mainly due to the presence of trachomatous gran- 
ulations. 

Paracentesis. — Surgical puncture of a cavity; to draw off 
fluid; tapping. 

Pathogenic, Pathogenetic. — Giving origin to disease or to 
morbid symptoms. 

Pharmacopeia, Pharmacopoeia. — An authoritative treatise 



144 THE OPHTHALMIC NURSE 

on drugs and their preparations. The United States Pharma- 
copeia is revised and issued every ten years, under the super- 
vision of a national committee. 

Pink-eye. — An epidemic, contagious conjunctivitis due to 
the bacillus of conjunctivitis. 

Pipet, Pipette. — A glass tube used in handling small quan- 
tities of liquid or gas. 

Presbyopia. — Long sight and impairment of vision due to 
advancing years or to old age. It is dependent on diminution 
of the power of accommodation from loss of elasticity of the' 
crystalline lens, causing the near-point of distinct vision to be 
removed farther from the eye. 

Prognosis. — A forecast as to the probable result of an at- 
tack of disease; the prospect as to recovery from a disease 
afforded by the nature and symptoms of the case. 

Prolapse. — The falling down, or sinking, of a part or viscus; 
procidentia. 

Prophylaxis. — The prevention of disease; preventive treat- 
ment. 

Ptyalism. — Excessive secretion of spittle; salivation. 

Purgative. — i. Cathartic; causing evacuations from the 
bowels. 2. A cathartic medicine. 

Purulent. — Consisting of or containing pus; associated with 
the formation of or caused by pus. 

Reaction. — Opposite action, or counteraction; the response 
of a part to stimulation. 

Reflex. — i. Reflected. 2. A reflected action or movement. 



GLOSSARY 145 

Sanguine. — 1. Abounding in blood. 2. Ardent; hopeful. 

Sclerotomy. — Surgical incision of the sclera. 

Senile. — Of, or pertaining to, old age. 

Serum. — The clear portion of any animal liquid separated 
from its more solid elements; especially the clear liquid {blood- 
serum) which separates in the clotting of blood from the clot 
and the corpuscles. Blood-serum from animals that have 
been inoculated with bacteria or their toxins. Such serum, 
when introduced into the body, produces passive immuniza- 
tion by virtue of the antibodies which it contains. 

Shock. — Sudden vital depression, due to an injury or emo- 
tion which makes an untoward impression upon the nervous 
system. 

Siphon. — A bent tube of two unequal arms: used in the 
transfer of liquids, also in wound-drainage and in lavage of the 
stomach. 

Solvent. — 1. Dissolving; effecting a solution. 2. A liquid 
that dissolves or that is capable of dissolving. 

Specific. — 1. Pertaining to a species. 2. Produced by a 
single kind of micro-organism. 3. A remedy specially indi- 
cated for any particular disease. 

Sphincter. — A ring-like muscle which closes a natural 
orifice. 

Strabismus. — A squint; deviation of one of the eyes from 
its proper direction, so that the visual axes cannot both be 
directed simultaneously at the same objective point. 

Suppository. — An easily fusible medicated mass to be in- 
troduced into the vagina, rectum, or urethra. 



146 THE OPHTHALMIC NURSE 

Suprarenal Capsule. — A small organ in front of the upper 
part of either kidney. 

Sympathetic Ophthalmia. — Inflammation of the iris and 
of the ciliary apparatus following disease or injury of the 
fellow-eye. 

Technic. — The method of procedure and the details of any 
mechanical process or surgical operation. 

Tenotomy. — The cutting of a tendon, as for strabismus or 
club-foot. 

Toxicity. — The quality of being poisonous, especially the 
degree of virulence of a toxic microbe or of a poison. 

Trachoma. — Contagious granular conjunctivitis, or granu- 
lar lids; a disease of the conjunctiva attended by the forma- 
tion of small elevations on the conjunctiva of the lids and by 
atrophy, cicatricial contraction, and deformity of the lids. 

Traumatism. — i. A condition of the system due to an in- 
jury or wound. 2. A wound. 

Vehicle. — A liquid substance in which a medicine is dis- 
solved or incorporated. 






CATECHISM 



DIRECTIONS FOR USING 

[The first figure indicates the page; the second figure, the line on 
the page.] 

The questions asked in this Catechism cover everything of any 
importance pertaining to ophthalmic nursing. 

After a thorough perusal of the preceding chapters, and perhaps 
a review of same, the nurse should write down on paper the answer 
to each question, numbering them accordingly. When all of these 
questions have been answered in this way she may refer to the page 
and line indicated by the number after each question to see how 
correctly she answered it. She should mark the questions which 
are not satisfactorily answered, again review the subject matter per- 
taining thereto, and after a lapse of a few days, repeat the examining 
process as described above. 

1. What is the shape of the orbit? 22—6. 

2. Of how many bones does the orbit consist, and what are they? 

22—8. 

3. What is the function of the orbital fat? 23 — 5. 

4. What is the length of the average eyeball? 23 — 7. 

5. Of how many tunics or coats is the eyeball composed? 23 — 8. 

6. Of what is the first tunic of the eyeball composed? 23 — 9. 

7. Describe the cornea. 23 — 10. 

8. In what way is the cornea nourished? 23 — 13. 

9. Describe the nerve supply of the cornea. 23 — 15. 

10. Describe the sclera. 23—22. 

11. By what is the sclera perforated? 23 — 26. 

12. What are the venae vorticosae? 23 — 28. 

13. Of what is the second or middle coat of the eyeball composed? 

24—3. 

14. What is the uveal tract? 24 — 5. 

15. How does the iris derive its name? 24 — 7. 

16. Upon what does the color of the iris depend? 24 — 9 

17. What makes the eye of the albino pink in color? 24 — 10. 

147 



148 THE OPHTHALMIC NURSE 

18. What color have all eyes at birth? 24 — 14. 

19. At what age does the iris change color? 25 — 1. 

20. Why are dark colored eyes stronger than light colored ones? 

25—2. 

21. Describe the anterior and posterior chambers of the eye. 25 — 5. 

22. Describe the muscular system of the eyes. 25 — 7. 

23. What muscular fibers of the iris cause contraction of the pupil? 

25—7. 

24. What muscular fibers of the iris cause dilation of the pupil? 

25—8. 

25. Describe the ciliary body. 25 — 10. 

26. Descrilx? the ciliary muscle. 25 — 15. 

27. Describe the choroid. 25 — 18. 

28. What is the function of the choroid? 25—19. 

29. Of what is the third or inner tunic of the eyeball composed? 

25—23. 

30. Describe the retina. 25 — 24. 

31. What is the function of the retina? 25 — 27. 
M. What is the optic disk or papilla? 26 — 3. 

33. What is the fovea centralis? 26 — 6. 

34. What is the timet ion of the fovea cent talis? 26 — 9. 

35. What is the macula lutea? 2(5 1-'. 

36. How many humors within the eyi ? 26—15. 

37. Describe the aqueous humor. 27 — 1. 

38. How is the aqueous humor secreted? 27 — 3. 

39. What is the function of the aqueous humor? 27 — 4. 

40. Descrilx.' the crystalline lens. 27 — 8. 

41. What is the ciliary ligament? 27 — 12. 

42. From what source does the ciliary ligament receive its nourish- 

ment? 27—14. 

43. Explain the method in which the lens adjusts itself for vision 

at different distances. 27 — 15. 

44. Describe the vitreous humor. 28 — 3. 

45. What is the hyaline membrane? 28 — 5. 

46. How does the vitreous humor receive its nourishment? 28 — 8. 

47. Describe the pupil. 28—9. 

48. What is the function of the pupil? 28—11. 

49. What is the average diameter of the pupil when the iris is at 

rest^ 28—14. 

50. How does the pupil vary in people of different teni|X'raments? 

28—16. 

51. Does the pupil change in size with age, and if so, how? 29 — 3. 



CATECHISM 149 

52. What other general conditions affect, the size of the pupil? 

29—4. 

53. What refractive errors have any influence on the size of the 

pupil? 29 — 5. 

54. How does general anesthesia affect the pupil? 29 — 9. 

55. How is the pupil affected by distant and close vision? 29 — 10. 

56. How does the general health affect the pupil? 29 — 12. 

57. How many muscles are there which perform all the movements 

necessary in the function of vision? 29 — 14. 

58. Is sight a passive or an active function? 30 — 2. 

59. How many external ocular muscles are there, and what are 

they? 30—9. 

60. Describe the internal rectus muscle. 30 — 10. 

61. Describe the external rectus muscle. 30 — 13. 

62. Describe the inferior rectus muscle. 30 — 16. 

63. Describe the superior rectus muscle. 31 — 2. 

64. Describe the superior oblique muscle. 31 — 5. 

65. Describe the inferior oblique muscle. 31 — 10. 

66. What is the function of the eyebrows? 31 — 15. 

67. What is the function of the eyelids? 31—19. 

68. Describe the eyelids. 31—20. 

69. Describe the conjunctiva. 31 — 25. 

70. What is the palpebral conjunctiva? 32 — 1. 

71. What is the bulbar conjunctiva? 32 — 2. 

72. Describe the epithelial layer of the conjunctiva. 32 — 2. 

73. Describe what happens when a foreign substance gets into the 

eye. 32—5. 

74. When are the conjunctival blood-vessels visible and when 

invisible? 32 — 9. 

75. What are the cilia of the eye? 32—12. 

76. What is the principal function of the cilia? 32 — 13. 

77. Describe the Meibomian glands. 32 — 17. 

78. What seems to be the function of the Meibomian, glands? 

32—18. 

79. Of what does the lacrimal apparatus consist? 33 — 1. 

80. Describe the lacrimal gland. 33 — 3. 

81. What is the function of the lacrimal gland? 33 — 5. 

82. Describe the lacrimal punctae. 33 — 6. 

83. What is the function of the lacrimal secretion? 34 — 3. 

84. Why do the tears run over the cheek when one cries? 34 — 6. 

85. Through what tissues of the eye do rays of light enter before 

they become focused upon the retina? 35 — 1. 



150 THE OPHTHALMIC NURSE 

86. Describe the eye with normal refraction. 35 — 4. 

87. Describe the near-sighted eye. 35 — 7. 

88. Describe the far-sighted eye. 35 — 9. 

89. How does the focusing in the eye differ from that in the camera? 

36—6. 

90. Describe the change which takes place in the lens during the 

act of accommodation. 37 — 1. 

91. Describe accommodation. 37 — 6. 

92. Why is the near-sighted eye not required to accommodate as 

much as the far-sighted eye? 37 — 12. 

93. Why is the far-sighted eye required to accommodate more than 

the eye with normal refraction? 38 — 1. 

94. How are refractive errors corrected? 38 — 5. 

95. What kind of lens is required in the correction of near-sighted- 

ness? 38—8. 

96. What kind of lens is required in the correction of far-sighted- 

ness? 38—11. 

97. What is the cause of so-called "old sight"? 39 — 6. 

98. At what age does old sight manifest itself? 39 — 16. 

99. What condition besides age will hasten old sight? 39 — 18. 

100. Why are people with a small amount of near-sightedness apt 

to neglect the correction of same? 40 — 1. 

101. Near-sighted in >s hit uncorrected will do what 5 40 — 4. 

102. How is blindness frequently caused by progressive near-sighted- 

ness? 40 — 6. 

103. What causes detachment of the retina in high degrees of near- 

sightedness? 40 — 7. 

104. Describe astigmatism. 40 — 12. 

105. To what is astigmatism due? 41 — 2. 

106. How many kinds of astigmatism are there? 42 — 3. 

107. Describe simple far-sighted astigmatism. 42 — 4. 

108. Describe simple near-sighted astigmatism. 42 — 7. 

109. Describe compound far-sighted astigmatism. 42 — 9. 

110. Describe compound near-sighted astiqmatism. 42 — 11 

111. Describe mixed astigmatism. 42 — 13. 

112. Describe irregular astigmatism. 42 — 14. 

113. What care should be taken of the newborn babe's eyes? 

43—4. 

114. What eye disease is responsible for two-thirds of the inmates 

of our blind institutions? 43 — 15. 

115. What precaution should be taken relative to exposure of 

infants' eyes to bright light? 43 — 18. 



CATECHISM 151 

116. What is the harm of holding objects too close to the eyes of 

infants? 44 — 13. 

117. What eye diseases are likely to occur during the period of 

teething? 44 — 16. 

118. W T hat is a common cause of cataract in children? 44 — 18. 

119. Why should the eyes not be used a great deal for close work 

at an early age? 44 — 20. 

120. Why should every child undergo a thorough examination of 

the eyes before entering upon school life? 44 — 25. 

121. What are some of the causes of near-sightedness? 45 — 3. 

122. What is the longest period of time that a child of six or seven 

should be allowed to use his eyes for close work? 45 — 11. 

123. Why should mental work not be required of a child immediately 

after a meal? 45—15. 

124. What kind of books should be placed in the hands of young 

children? 45—21. 

125. W T hy should patients not be allowed to read while lying down 

or while convalescing from disease? 46 — 3. 

126. How should a boric acid solution be instilled into the eyes? 

47—5. 

127. How should poisonous solutions be instilled into the eyes? 

48—9. 

128. How are little children best managed when drops are to be 

instilled into their eyes? 49 — 9. 

129. What precaution should be taken regarding the use of the 

pipet? 50—8. 

130. What precaution should be taken regarding the pipet used in 

contagious eye diseases? 51 — 8. 

131. What precaution should be taken regarding the use of a pipet 

which has been previously used for a mydriatic? 51 — 10. 

132. When and how should a bulb syringe be used in eye cases? 

51—16. 

133. How is the eye-cup used? 51 — 20. 

134. Why should a camel's-hair brush not be employed in the 

application of fluid to the eye? 52 — 5. 

135. What precaution should be observed regarding the use of 

poisonous solutions in the eyes of small children? 52 — 8. 

136. Describe the symptoms of atropism. 52 — 16. 

137. How would you evert the lower lid? 53 — 10. 

138. How would you evert the upper lid? 53 — 13. 

139. W T hat effect upon the eye do cold packs have? 54 — 6. 

140. In what class of eye cases are cold packs used? 55 — 3. 



152 THE OPHTHALMIC NURSE 

141. What precaution should be used regarding the use of cold 

packs on the eye? 55 — 4. 

142. What is the advisable thing to do with injuries of the eye when 

seen early? 55 — 7. 

143. What effect do hot packs have upon the eye? 55 — 11. 

144. In what class of eye cases are hot packs indicated? 55 — 13. 

145. Why are hot packs especially indicated in inflammation of the 

cornea? 55 — 15. 

146. How are dry hot packs prepared for use on the eye? 56 — 4. 

147. How are moist hot packs prepared for use on the eye? 56 

—6. 

148. How are cold packs prepared for use on the eye? 57 — 1. 

149. How should the face l>e prepared for hot or cold packs? 57 — 14. 

150. How are ointments applied in the i —3. 

151. How are powders applied in the eye? 59 — 9. 

152. In what class of eye cases are poultices used? 59 — 15. 

153. What effect does massage have upon the eye? 59 — 21. 

154. In what class of cases is massage of the eye contraindicated? 

60—2. 

155. How is massage of the eyes applied? 60 — 5. 

156. What forms of electricity an- used in eye work? 61 — 10. 

157. In what class of eye cases is electricity used? 61 — 11. 

158. How is the galvanic current used on the eye? 61 — 15. 

159. In what class of eye cases are leeches employed? 61 — 24. 

160. What effect docs leeching have upon an inflamed eye? 61 — 27. 

161. Where are the best leeches from? 62 — 2. 

162. How much blood will an ordinary leech extract? 62 — 2. 

163. How are leeches tested? 62 — 4. 

164. W'here and how are leeches applied? 62 — 7. 

165. How are leeches removed? 62 — 17. 

166. What is the most satisfactory method of local depletion in eye 

diseases? 62 — 20. 

167. If continued bleeding is desired after leeching how may it be 

accomplished? 63 — 5. 

168. How may bleeding from a leech bite l>e checked? 63 — 6. 

169. For what purpose are counterirritants used? 63 — 17. 

170. What remedies are generally used as counterirritants? 63 — 18. 

171. Where are they usually applied? 63 — 19. 

172. In what class of cases are mercurial inunctions applied? 64 — 7. 

173. What preparation of mercury is generally used for inunction? 

64—10. 

174. How are inunctions applied? 64 — 12. 



CATECHISM 153 

175. What precautions should be taken while using mercurial in- 

unctions? 64 — 21. 

176. In what class of eye cases is sweating or diaphoresis indicated? 

65—3. 

177. What do we usually do to produce diaphoresis? 65 — 5. 

178. Why is rest a necessary adjunct in the treatment of eye dis- 

eases? 65 — 15. 

179. What remedies do we frequently give to induce sleep? 65 — 19. 

180. How can the eyes be rested other than by sleep? 65 — 25. 

181. What class of eye diseases are contagious? 66 — 3. 

182. How should purulent eye cases be managed? 66 — 8. 

183. What precautions should the nurse take in handling purulent 

eye cases? 66 — 12. 

184. What should the nurse do if she infects her own eye while 

treating a purulent case? 66 — 16. 

185. W T hat precaution should be taken when a purulent disease is 

limited to one eye? 66 — 22. 

186. Describe a Buller's shield. 66—28. 

187. How may the unaffected eye of an infant be protected against 

discharge from the affected eye? 67 — 6. 

188. What is the most common purulent affection in childhood? 

67—16. 

189. How long after birth does ophthalmia neonatorum appear? 

68—4. 

190. What is ophthalmia neonatorum? 68 — 5. 

191. Why is the eye a favorable ground for the growth of micro- 

organisms? 68 — 16. 

192. What is the most important step in the treatment of purulent 

eye cases? 68 — 20. 

193. What solutions are generally used for cleansing purulent eyes? 

68—23. 

194. How can ophthalmia neonatorum usually be prevented? 

69—13. 

195. What routine treatment should be pursued with all new- 

born babes? 69—18 and 70—7. 

196. What unfavorable action upon the eye does the instillation of 

silver nitrate solutions have at times? 69 — 23. 

197. When a silver nitrate solution is used in the eye how should it 

be applied? 70 — 1. 

198. What particular observations should be made by the nurse in 

cases that are being prepared for eye operation? 71 — 12. 

199. Describe preparation of patient for eye operation. 72 — 3. 



154 THE OPHTHALMIC NURSE 

200. Describe the way a woman's hair should be dressed preparatory 

to an eye operation. 72 — 13. 

201. How should the eye be prepared preliminary to an eye opera- 

tion? 73—4. 

202. What should the diet be preliminary to an eye operation? 

73—14. 

203. In selecting the room for an operation at patient's home what 

conditions should be considered? 74 — 6. 

204. If artificial light is necessary for the operation what particular 

light is most desirable? 74 — 10. 

205. What objection is there to lamp or gas light where operations 

are to be performed under a general anesthetic? 7-1 — 12. 

206. How should the room at one's home be prepared for an opera- 

tion? 74 — 17. 

207. What preparation should be made at one's home for the opera- 

tion? 74—25. 

208. How should the bed of a patient be prepared who has un<l< 

an operation under general anesthesia? ~. ; — 28. 
20°. What precaution should be taken regarding the sterilization of 
cutting eye instruments? 76 — 15. 

210. How should non-cutting eye instruments be sterilized? 76 — 18. 

211. How are cutting eye instruments tested? 77 — 3. 

212. How are cutting eye instruments prepared for operat ion? 

77—7. 

213. What precaution should be taken in handling cutting eye 

instruments? 77 — 14. 

214. How should the solutions be prepared for eye operations? 

77—21. 

215. What is a good way of preparing solutions for eye operations 

at the home? 78 — 1. 

216. Which is preferable, the sterilization of dressings by dry heat 

or by steam? 78 — 8. 

217. What are the usual dressings required for most eye operation^ 

78—12. 

218. Why is it especially necessary for the nurse who assists in 

operations to have her hands absolutely sterile? 78 — 1 7. 

219. How should the hands be prepared preliminary to an operation? 

78—20. 

220. How should a patient be prepared when brought in the operat- 

ing room? 79 — 2. 

221. Why should the nurse familiarize herself with the technic of 

the various eye operations? 79 — 11. 






CATECHISM 155 

222. What is the proper temperature of the operating room? 79 

—18. 

223. What are the duties of the nurse after completion of an eye 

operation? 79 — 22. 

224. What kind of bandage is applied after an operation upon the 

eyeball like cataract extraction or iridectomy? SO — 2. 

225. Describe the Knapp dressing. 80 — 3. 

226. Describe the figure-of-8 bandage. 80 — 8. 

227. Describe the monocular bandage. 81 — 6. 

228. For what two purposes are bandages applied? 81 — 9. 

229. In what class of eye cases is the pressure bandage applied? 

81—10. 

230. In what class of eye cases is the protective bandage applied? 

81—13. 

231. What should the nurse do if the bandage becomes disarranged? 

82—5. 

232. What should the nurse do if the patient interferes with his 

bandage? 82—9. 

233. What should the nurse do if blood or discharge shows through 

a pressure bandage? 82 — 11. 

234. Why is it necessary to cover a pressure bandage through which 

discharge or blood shows? 82 — 13. 

235. How should a patient be removed from the operating table 

when operation has been done under a local anesthetic? 
82—21. 

236. What should be done with all pathologic specimens which 

have been removed by operation? 83 — 4. 

237. What precautions should be observed after patient has been 

removed to his own room following operation under general 
anesthesia? 84 — 12. 

238. What precautions should be taken relative to a patient with both 

eyes bandaged? 85 — 1. 

239. What observation should be made relative to the patient's 

temperature following an operation upon the eye? 85 — 3. 

240. What should the nurse do in case the patient complains of pain 

after operation upon the eye? 85 — 8. 

241. What should be done if patient complains of chill or sudden 

weakness after an eye operation? 85 — 15. 

242. What should be done if the patient feels disposed to sneeze 

after cataract operation? 85 — 18. 

243. If there is a tendency for the patient to vomit after cataract 

operation what should the nurse do? 85 — 20. 



156 THE OPHTHALMIC NURSE 

244. What should be done in case symptoms of shock are manifest 

after an operation on the eye? 85 — 28. 

245. What are the symptoms of shock? 86—2. 

246. If suppuration, iritis, or prolapse of the iris take place in an 

eye which has been successfully operated upon, what are we 
naturally to assume? 86 — 12. 

247. How should a patient lie during the first twenty-four hours 

after a cataract operation? 86 — 24. 

248. If a cataract patient finds his position irksome what should the 

nurse do? 86 — 26. 

249. What diet should be given for the first few days after a cat- 

aract operation? 87 — 1. 

250. What medicine is generally administered for the first ten or 

twelve hours following cataract operations? 87 — 4. 

251. Why should cathartics never be administered within four days 

after cataract operations? 87 — 7. 

252. What should be done in case urination is difficult alter cataract 

operations? 87 — 13. 

253. Why are patients who have had cataract operations prone to 

suffer from depression? 87 — 18. 

254. I low may such depression be warded off? < v> 7 — 20. 

255. How many days after cataract extraction is the bandage 

usually removed from the non-operated eye? 87 — 23. 

256. What precaution should be taken at the time the bandage is 

removed from the Don-operated eye? 87 — 25. 

257. What preparation should the nurse make for the surgeon's 

call after cataract operations? 88—4. 

258. What should the eye tray contain? 88—15. 

259. What are local anesthetics? 90—6. 

260. Under what form of anesthesia are most ophthalmic operations 

performed? 90 — 9. 

261. Name the local anesthetics used in eye work. 90 — 11. 

262. What are analgesics? 90— 13. 

263. Name the analgesics used in eye work. 90 — 19. 

264. What are antiseptics? 90 — 22. 

265. In what class of eye cases are antiseptics used? 91 — 2. 

266. Name the principal antiseptics used in eye work. 91 — 6. 

267. What are astringents? 91 — 11. 

268. Name the principal astringents used in ophthalmology. 91 — 17. 

269. What are caustics? 91—21. 

270. For what are caustics used in eye work? 91 — 22. 

271. Name the caustics used in eye work. 91 — 26. 



CATECHISM 157 

272. What are counterirritants? 92 — 1. 

275. Name the counterirritants used in eye work. 92 — 4. 

274. What are disinfectants? 92 — 5. 

275. Name some of the disinfectants used in eve work. 92 — 7. 

276. What are emollients? 92 — 9. 

277. What are the emollients used in eye work? 92 — 12. 

278. What are germicides? 92 — 15. 

279. What are hemostatics? 92 — 17. 

280. What are irritants? 92—19. 

281. In what different classes are irritants divided? 92 — 21. 

282. What are rubefacients? 92—22. 
285. What are epispastics? 92 — 23. 

284. What are pustulants? 92 — 24. 

285. Name the principal irritants used in ophthalmic work. 92 — 27. 

286. What are lymphagogues? 93 — 1. 

287. What is the principal lymphagogue used in ophthalmology? 

93—3. 

288. What are mydriatics? 93 — 4. 

289. Name the principal mydriatics used in ophthalmology. 93 — 8. 

290. What are myotics? 93 — 11. 

291. What other effect on the eye do mydriatics have besides 

dilating the pupil? 95 — 16. 

292. What other effect on the eye besides contracting the pupil do 

myotics have? 93 — 17. 

293. What are the principal myotics used in ophthalmology? 93 — 18. 

294. What are refrigerants? 93 — 19. 

295. Name a refrigerant. 93 — 21. 

296. What are local sedatives? 93 — 24. 

297. What are staining agents used for in eye work? 93 — 26. 

298. Xame the principal staining agents used in ophthalmology. 

94—3. 

299. What are stimulants? 94—4. 

300. Xame the principal stimulants used in ophthalmology. 94 — 6. 
501. What are styptics? 94—8. 

302. What are vasoconstrictors? 94 — 10. 

303. What is the principal vasoconstrictor used in eye work? 94 — 13. 

304. What are vasodilators? 

305. What are the principal vasodilators used in eye work? 94 — 14. 

306. What are vesicants? 94 — 17. 

307. Tell all you can about acacia. 95 — 1. 

308. Tell all you can about acetic acid. 95 — 11. 

309. For what purpose is acoin used in the eye? 95 — 16. 



158 THE OPHTHALMIC NURSE 

310. How should a solution of acoin be made? 95 — 20. 

311. How should a solution of acoin be kept? 96 — 4. 

312. Tell all you know about actol. 96 — 6. 

313. Adrenalin chlorid is derived from what? 96 — 9. 

314. In what class of eye cases is adrenalin chlorid used? 96 — 13. 

315. What other remedy reinforces the action of adrenalin chlorid? 

96—20. 

316. Why should adrenalin chlorid not be used in the eyes for any 

length of time? 96—23. 

317. What effect does air and light have on a solution of adrenalin 

chlorid? 96—27. 

318. What isadrin? 97—1. 

319. In what class of eye diseases is alum sulphate used? 97 — 5. 

320. In what class should alum never be used? 97 — 13. 

321. What is alypin? 97—18. 

322. How does alypin compare in it > effect with that ol 1 

97—19. 

323. What strength of solution of alypin is generally used in eye 

work? 97—25. 

324. What is amyl nitrite? 98—1. 

325. For what purpose is the inhalation of amyl nitrite used some- 

times in ophthalmology? 98 — 6. 

326. What is argonin? 98—15. 

327. How do the effects of argonin upon the eye differ from those of 

silver nitrite? 98— IS. 

328. In what particular eye diseases is argonin used? 98 — 21. 

329. What is argyrol? 98—23. 

330. In what respect is argyrol preferable to silver nitrite in eye 

work? 98—24. 

331. What strength solutions of argyrol are used in eye work? 

98—27. 

332. What precautions should be taken in the use of argyrol? 99 — 2. 

333. Why are fresh solutions of argyrol preferable to old ones? 

99—8. 

334. How should a solution of argyrol be kept? 99 — 9. 

335. What is aristol? 99—13. 

336. In what respect is aristol preferable to iodoform? 99 — 17. 

337. In what class of eye cases is aristol used? 99 — 19. 

338. What is atropin? 99—24. 

339. What strength solutions of atropin are used in eye work? 

99—27. 

340. What effect does atropin have upon the eye? 99 — 28. 



CATECHISM 159 

341. How long after instillation are the effects of atropin complete? 

100—6. 

342. How long do the effects of atropin last? 100 — 7. 

343. In what class of eye cases is atropin contraindicated? 100 — 10. 

344. In what particular affection is atropin dangerous? 100 — 12. 

345. What are the symptoms of atropin poisoning? 100 — 16. 

346. What are the antidotes for atropin poisoning? 100 — 20. 

347. What precautions should the nurse take after instilling atropin 

in a patient's eyes? 100 — 22. 

348. In what form is atropin the safest to use in eye work? 100 — 24. 

349. What is boric acid? 101—1. 

350. What strength solution of boric acid is used in eve work? 

101—5. 

351. What other medicine added to a boric acid solution renders it 

more soluble and effective? 101 — 10. 

352. What is the easiest and most simple method of preparing a 

saturated solution of boric acid? 101 — 16. 

353. For what purpose is calomel dusted into the eye? 102 — 1. 

354. Why should calomel never be used in the eyes at a time when 

the patient is taking any of the iodids internally? 102 — 3. 

355. What is camphor? 102—8. 

356. What effect does camphor-water have upon the eye? 102 — 12. 

357. What is cantharides? 102—14. 

358. For what purpose is cantharides used in eye work? 102 — 14. 

359. What is the most convenient method of applying cantharides? 

102—20. 

360. What is carbolic acid? 102—22. 

361. For what purposes in eye work is carbolic acid used? 103 — 1. 

362. How is carbolic acid used as a caustic for corneal ulcers? 

103—7. 

363. From what is castor oil obtained? 103 — 14. 

364. For what purpose is castor oil used in the eye? 103 — 15. 

365. For what is it especially useful as a solvent? 103—19. 

366. In what class of eve cases is chlorin-water generally used? 

103—26. 

367. How should chlorin-water be kept? 104 — 1. 

368. What is cocain? 104—3. 

369. In what strength solutions is it employed in eye work? 104 — 5. 

370. What other remedy makes a good preservative of cocain solu- 

tions? 104 — 8. 

371. How can the smarting of cocain when dropped into the eye be 

prevented? 104—11. 



160 THE OPHTHALMIC NURSE 

372. What effect upon the eye does cocain have besides anesthetiz- 

ing it? 104—16. 

373. How many instillations and how much time is generally re- 

quired in thoroughly anesthetizing an eye with cocain? 104 
—24. 

374. How long does the anesthesia of cocain last? 104 — 28. 

375. What other remedy renders the action of cocain more active? 

105—6. 

376. Explain how cocain increases the effect of mydriatics. 105 — 9. 

377. Why should cocain not be used continually in the eyes for 

days? 105-13. 

378. What precaution should be taken in using a bichlorid of mer- 

cury solution stronger than 1 : 10,000 in an eye that has been 
cocainized? 105 — 16. 

379. How may cocainism lx> prevented from the use of cocain in the 

eye? 105—21. 

380. What are the symptoms of cocainism? 106 — 1. 

381. What should one do in a case of cocainism? 106 — 3. 

382. What is collodion? 106—7. 

383. For what purpose is collodion used in eye work? 106 — 8. 

384. To what class of remedies docs copper sulphate l>elong? 106 

— 15. 

385. For what particular eye disease is copper sulphate used? 

106—17. 

386. What particular objection is there to copper sulphate in eye 

work? 106— IS. 

387. What remedy used alter application of copper sulphate to tin- 

lids will render it less painful? 106 — 22. 

388. For what purpose is croton oil sometimes used in eye work? 

106—26. 

389. What particular action does dionin have upon the eye? 107 

—3, 107—12. 

390. In what particular class of eye cases is dionin indicated? 

107—10. 

391. What symptoms usually immediately follow the use of a 

dionin solution in the eye? 107 — 15. 

392. What strength solution of dionin is generally used in the eye? 

107—19. 

393. How do the effects of duboisin in the eye differ from that of 

atropin? 108—12. 

394. W T hat strength of duboisin solutions are generally used in the 



CATECHISM 161 

395. How long after the instillation of a duboisin solution in the 

eye does its effect last? 108 — 14. 

396. In what particular class of eye cases is duboisin indicated? 

108—15. 

397. What effect does a solution of ephedrin have upon the eye? 

108—19. 

398. What is eserin sulphate? 108—22. 

399. How does eserin sulphate come commercially? 108 — 24. 

400. What effect does light and air have on eserin sulphate? 108 — 

25. 

401. What is a good way of preserving eserin powder after the phial 

has once been opened? 109 — 1. 

402. What color should a freshly made eserin solution be? 109: — 2. 

403. What color does an eserin solution become with age? 109 — 4. 

404. How does a solution of eserin affect the eye after it has changed 

color? 109—6. 

405. What strength solution of eserin is generally employed in eye 

work? 109—9. 

406. What effect upon the eye does eserin have? 109 — 10. 

407. What other remedy increases the effect of eserin in the eye? 

109—15. 

408. What is a good substitute for eserin when the latter is not 

well borne? 109—18. 

409. How does eucain differ in its effect upon the eye from cocain? 

109—19. 

410. For what purpose is euphthalmin used in eye work? 109 

—24. 

411. What strength solution of euphthalmin is generally employed 

in eye work? 109 — 27. 

412. How long do the effects of euphthalmin last? 110 — 1. 

413. How do the effects of euphthalmin in the eye differ from those 

of cocain? 110 — 2. 

414. For what purpose is fluorescein used in the eye? 110 — 7. 

415. What is the difference between formalin and formaldehyd? 

110—18. 

416. For what purpose is formalin sometimes used in eye work? 

110—21. 

417. What effect upon the eye does glycerin have? Ill — 5. 

418. How does glycerin influence the effect of silver nitrate upon 

the eye? 111—9. 

419. To what class of medicines does holocain belong? Ill — 17. 

420. How should a holocain solution be made? Ill — 20. 



162 THE OPHTHALMIC NURSE 

421. How do the effects of holocain upon the eye compare with 

those of cocain? Ill — 27. 

422. For what purpose is homatropin used in eye work? 112 — 14, 

112—17. 

423. How do the effects of homatropin in the eye compare with 

those of atropin? 112 — 15. 

424. What other medicine increases the effect of homatropin in the 

eye? 112—20. 

425. To what class of remedies does hydrogen peroxid belong? 

112—21. 

426. In what class of eye cases is hydrogen peroxid sometimes used? 

112—25. 

427. What strength solution of hydrogen peroxid is generally used 

in eye work? 112 — 28. 

428. How is hydrogen peroxid best kept? 113 — 3. 

429. To what class of remedies does hyoscin belong? 113 — 5. 

430. How do the effects of hyoscin differ from those of atropin? 

113—6. 

431. What action on the eye does hyoscyamin have? 113 — 14. 

432. How long do the effects of hyoscyamin last? 1 13 — 16. 

433. What strength solution of hyoscyamin is generally used in eye 

work? 113—19. 

434. How should a solution of hyoscyamin be kept? 113 — 20. 

435. From what is tincture of iodin derived? 113 — 22. 

436. For what purpose is tincture of iodin sometimes used in eye 

work? 113—23. 

437. For what purpose is iodoform sometimes used in eye work? 

114—5. 

438. What is the principal objection to iodoform in eye work? 

114—9. 

439. Whatisitrol? 114—13. 

440. For what purpose is itrol sometimes used in eye work? 114 

—15. 

441. For what purpose is lead acetate sometimes used in eye work? 

114—18. 

442. What precaution should be taken in the use of lead acetate in 

eye cases? 114 — 19. 

443. How is mercurial ointment frequently used in ophthalmic 

cases? 114 — 25. 

444. What solution of mercury bichlorid is used in eye work? 1 1 .5 — 2. 

445. In what class of eye cases should mercury bichlorid not be 

used? 115 — 5. 



CATECHISM 163 

446. What is the objection to using mercury bichlorid solutions in 

an eye in which cocain has also been used.'* 115 — 7. 

447. For what purpose is mercury cyanid sometimes used in eye 

work? 115—22. 

448. In what class of eye cases is yellow oxid of mercury ointment 

sometimes used? 115 — 26. 

449. In what respect do the effects of nargol differ from those of 

silver nitrate? 116 — 16. 

450. In what class of eye cases is nargol frequently used? 116 — 19. 

451. What is novocain? 116 — 23. 

452. What strength solution of novocain is generally used in eye 

work? 116—25. 

453. For what purpose is olive oil sometimes used in eye work? 

117—4. 

454. What is pilocarpin? 117 — 11. 

455. What effect upon the eye does pilocarpin have? 117 — 12. 

456. In what respect do the effects of pilocarpin differ from those of 

eserin? 117 — 12. 

457. Pilocarpin added to a cocain solution changes the effect of the 

latter in what respect? 117 — 16. 

458. For what purpose is pilocarpin frequently administered hypo- 

dermically? 117—19. 

459. In what class of eye cases is potassium permanganate sometimes 

used? 117—25. 

460. What particular objection is there against the use of potassium 

permanganate solutions in the eye? 117 — 26. 

461. To what class of remedies does protargol belong? 118 — 1. 

462. What strength solutions of protargol are used in eye work? 

118—3. 

463. How do the effects of protargol upon the eye differ from those 

of silver nitrate? 118 — 4. 

464. What is pyoctanin? 118 — 7. 

465. What effect upon tissues does pyoctanin have? 118 — 7. 

466. For what purpose is rose-water sometimes used in eye work? 

118—12. 

467. What effect does scopolamin have upon the eye? 118 — 14. 

468. In what class of eye cases is scopolamin especially useful? 

118—17. 

469. What is the oldest and most valuable astringent in ophthal- 

mology? 118—21. 

470. In what class of eye cases is silver nitrate especially used? 

118—22. 



THE OPHTHALMIC NURSE 



471. What per cent, solution of silver nitrate is generally used in 

eye cases? 118 — 25. 

472. How should silver nitrate be applied to the eye? 118 — 27. 

473. What effect upon the conjunctiva will a silver nitrate solution 

have if used too long? 119 — 2. 

474. In what class of eye cases is the use of silver nitrate contra- 

indicated? 119 — 4. 

475. How will the light affect a solution of silver nitrate? 1 19 — 7. 

476. For what purpose is sodium bicarbonate sometimes used in 

eye work? 119 — 16. 

477. For what purpose is sodium borate used in eye work? 119 — 21. 

478. What effect does sodium borate have when combined with a 

solution of boric acid? 119 — 22. 

479. For what purpose is sodium chlorid sometimes used in eye 

work? 119—25. 

480. To what class of remedies does tannic acid belong? 120 — 9. 

481. What effect upon the eye does a solution of tannic acid have? 

120—10. 

482. What per cent, solution of tannic acid is generally used in eye 

work? 120—14. 

483. For what purpose is vasclin frequently used in eye work? 

120 — 18. 

484. What strength solution of zinc sulphate is used in eye work? 

120—22. 

485. How do the effects of zinc sulphate on the eye compare with 

those of copper sulphate? 120 — 32. 

486. In what class of eye cases is zinc sulphate generally used? 

120—25. 
Describe the use of the following ophthalmic instruments: 

487. Tenotomy scissors. 124 — 13. 

488. Iris scissors. 124 — 17. 

489. Enucleation scissors. 124 — 21 

490. Chalazion clamp. 125 — 1. 

491. Ectropion forceps. 125 — 4. 

492. Iris forceps. 126—1. 

493. Cilia forceps. 126 — 3. 

494. Advancement forceps. 126 — 6. 

495. Capsule forceps. 126 — 8. 

496. Fixation lorceps. 126 — 11. 

497. Trachoma forceps. 126 — 13. 

498. Cataract knives. 126—17. 

499. Scalpel. 126—19. 



CATECHISM 165 

500. Curved bistoury. 126—21. 

501. Beers' knite. 126—23. 
502 Keratome. 126—25. 

503. Canaliculus knife. 127 — 1. 

504. Needle knives. 127—3. 

505. Paracentesis knife. 128 — 1. 

506. Blunt bistoury. 128—6. 

507. Lacrimal dilator. 128—8. 

508. Lacrimal probes. 128 — 10. 

509. Lacrimal syringe. 128 — 13 

510. Chalazion scoop. 128 — 15. 

511. Lens scoop. 128 — 17. 

512. Enucleation spoon. 128 — 20. 

513. Foreign body spud. 128 — 23. 

514. Strabismus hook. 128 — 25. 

515. Artificial leech. 129—1. 

516. Aluminum shield. 129 — 3. 

517. Eye speculum. 129 — 5. 

518. Lid retractor. 129—7. 

519. Needle holder. 129—10. 

520. Spatula. 129—11. 

521. Tattoo needle. 129—15. 

522. Trachoma file. 129—18. 

523. Strabismometer. 129 — 20. 

524. Cystotome. 129—22. 

525. Magnet. 129—25. 

526. Electrodes. 130—4. 

527. Test-drum. 131—1. 

528. Puncta clamp. 131 — 3. 

529. For what purpose is paracentesis of the cornea performed? 

132—1. 

530. What instruments are required to perform paracentesis of the 

cornea? 132 — 4. 

531. For what purpose is Saemisch's section performed? 132 — 6. 

532. What instruments are required for the Saemisch section? 

132—11. 

533. For what purpose is tattooing of the cornea performed? 132 

—13. 

534. What instruments are required for tattooing the cornea? 

132—19. 

535. For what purpose is tenotomy of the external ocular muscles 

performed? 133 — 1. 



1 66 THE OPHTHALMIC NURSE 

536. What instruments are required for a tenotomy operation? 

133—5. 

537. For what purpose is an advancement of an external ocular 

muscle performed? 133 — 8. 

538. What instruments are required for an advancement operation? 

133—12. 

539. For what purpose is shortening of the external ocular muscles 

performed? 133 — 16. 

540. What instruments are required for shortening the external 

ocular muscles? 133 — 20. 

541. For what purpose is the chalazion operation performed? 

133—24. 

542. What instruments are required for a chalazion operation? 

133—26. 

543. For what purpose is an ectropion operation performed? 134 — 3. 

544. What instruments are required for an ectropion operation? 

134—5. 

545. For what purpose is an entropion operation performed? 134 — 8. 

546. What instruments are required for an entropion operation? 

134—10. 

547. What instruments are required for cataract extraction? 

134—15. 

548. For what purpose is a needling operation performed? 134 — 18. 

549. What instruments are required for a needling operation? 

134—23. 

550. For what purpose is an anterior sclerotomy performed? 

135—1. 

551. What instruments are required for anterior sclerotomy? 135 

—3. 

552. For what purpose is a posterior sclerotomy performed? 135 — 5. 

553. What instruments are required for a posterior sclerotomy? 

135—8. 

554. Describe iridectomy. 135 — 10. 

555. For what purpose ban iridectomy performed? 135 — 11. 

556. What instruments are required for an iridectomy? 135 — 16. 

557. For what purpose is an iridotomy performed? 135 — 19. 

558. What instruments are required for an iridotomy? 136 — 1. 

559. For what purpose is discission of cataract performed? 136 — 3. 

560. What instruments are required for discission of cataract? 

136—9. 

561. What instruments are required for enucleation of the eyeball? 

136—12. 



INDEX 



Absorption by depletion, 61 

by massage, 59 

by sweating, 65 
Abstraction of blood, 61 
Acacia, 95 
Accommodation, 37 

illustrated, 37 
Acetate ol lead, 95 
Acetic acid, 95 
Acoin, 96 

Acute inflammation, 55 
Adrenalin chlorid, 96 
Adrin, 97 

Advancement forceps, 126 
illustrated, 125 

of muscles, 133 
Albino, 24 
Alum sulphate, 97 
Alypin, 97 
Amyl nitrite, 98 
Analgesics, 90 

list of, 90 
Anatomy of the eye, 22, 35 
Anesthesia, 29 

Anesthetic, general, after-care, 
75, 82, 84 
in home operations, 75 

local, 90 
Ante-operative nursing, 71 
Anterior chamber, 25 

ciliary arteries, 24 



Anterior ciliary nerves, 24 

sclerotomy, 135 
Antisepsis, 71 
Antiseptics, 90 

list of, 91 
Appendages of the eye, 31 
Aqueous humor, 25, 26 
Argonin, 98 
Argyrol, 70, 98 

in ophthalmia neonatorum, 69 
Aristol, 99 

Artificial leech, 63, 129 
illustrated, 63, 127 
pupil, 135 
teeth, 73 
Asepsis, 71 
Astigmatism, 40 

compound far-sighted, 41, 42 
illustrated, 41 
near-sighted, 41, 42 
illustrated, 41 
irregular, 42 
mixed, 42 

illustrated, 41 
simple far-sighted, 42 
illustrated, 40 
near-sighted, 42 
illustrated, 40 
Astringents, 91 

list of, 91 
Atropin, description of, 99 
167 



1 68 



INDEX 



Atropin, method of instillation, 
48, 52 
special pipet for, 51 
Atropism, 52 



Bandages, 78 
binocular, 80 
for rest, 65 
how applied, 81 
different kinds, 80 
monocular, 81 

illustrated, 81 
pressure, 81 
protective, 81, 82 
Bed of patient, 75 
Beer's knife, 126 

illustrated, 127 
Bichlorid of mercury for disin- 
fecting hands, 78 
in preparation of operative 

cases, 73 
in purulent cases, 66 
sheets wet with, 74 
with soap, 78 
Binocular bandage, 65, 80, 81 

vision, 30 
Birth, eyes at, 43 
Bistoury, 128 

illustrated, 127 
Blindness due to ophthalmia neo- 
natorum, 43 
in the United States, 68 
Blood abstraction, 61 
Blood-pressure, 85 
Books for children, 45 
Boric acid, 43, 70, 75 

description of, 101 
Brows, 31 
Bulb syringe, 51, 68, 131 

illustrated, 51, 68, 130 
Bulbar conjunctiva, 32 



Buller's shield, 66 
illustrated, 67 



Calomel, 102 
Camel's-hair brushes, 52 
Camera, likeness of eye to, 36 
Camphor, 102 
Camphor-water, 102 
Canaliculus knife, 127 

illustrated, 127 
Cantharides, 102 
Capsule forceps, 126 
illustrated, 125 

of the lens, 27, 39 
Carbolic acid, 102 
Castor oil, 103 
Cataract, 85 

cases, 87 

discission of, 136 

extraction of, 84, 134 

knife, 126 

illustrated, 127 

operations, 80, 81, 85, 86 

secondary operation, 134 
Catechism, 147 

Cathartics after cataract opera- 
tion, 87 
Caustics, 91 
Cautery, 61 
Chalazion clamp, 125 
illustrated, 125 

operation, 133 

scoop, 128 

illustrated, 127 
Cherry laurel water, 103 
Chill, 85 
Chloral, 65 
Chlorin-water, 103 
Chloroform, 74 
Choroid, 24, 25 

illustrated, 26 



INDEX 



169 



Cilia, 32 
forceps, 126 
illustrated, 125 
Ciliary body, 24, 25 
ligament, 27, 39 
muscle, 25, 27, 30, 39 
process, 25 
Circulation of the eye, 55 
Clamp, puncta, 131 
illustrated, 130 
Cleansing solutions, 47 
Cocain, description of, 104 
for operations, 75 
method of instilling, 48 
Codein after operations, 87 

to induce sleep, 65 
Cold compresses, 54, 55, 56, 57 

illustrated, 58 
Collodion, 106 

Compound far-sighted astigma- 
tism, 41, 42 
illustrated, 41 
near-sighted astigmatism, 41, 
42 
illustrated, 41 
Compresses, 54, 55, 56 
cold, 54, 55, 56, 57 

illustrated, 58 
hot, 54, 55, 56 
illustrated, 56, 57 
Conjunctiva, 31, 32 
bulbar, 32 
disease of, 55 
illustrated, 32 
palpebral, 32 
vessels of, 32 
Contagious eye diseases, 51, 66 
Convalescence, use of eyes dur- 
ing, 66 
Convex lenses, 38 
Copper sulphate, 106 
Cornea, anatomy of, 23 



Cornea, nutrition of, 55, 57 
operations of, 59, 61, 132 
tattooing the, 132 
ulceration of, 50, 55, 61, 70, 132 
Correction of retractive errors, 3S 
Cough, 71 
Counterirritants, 63, 92 

list of, 92 
Crossed eyes, 44 
Croton oil, 106 

Crystalline lens, anatomy of, 27 
function of, 35 
illustrated, 27 
in old age, 39 
Cup, eye-, 51 

illustrated, 52 
method of using, 51 
Cyclitis, hot packs in, 55 
inunctions in, 64 
leeching in, 61 
Cystotome, 129 
illustrated, 130 

Detachment of retina, 40 

illustrated, 39 
Diaphoresis, 65 
Diet, 73 

liquid, 87 
Digestion, 45 
Dilator, lacrimal, 128 

illustrated, 127 
Dionin, 107 

Discharge, 51, 66, 67, 68, 73 
Disinfectants, 92 

list of, 92 
Disk, optic, 26 

Dressings after operations, 79 
removal of, 79, 87 
sterilization of, 78 
Drops, eye, 47 

method of applying, 47 
illustrated, 47, 48, 49 



170 



INDEX 



Drops, eye, poisonous, 48 
Drum, test, 76, 77, 131 
illustrated, 76, 130 
Dry heat, 56 
Duboisin, 108 
Duct, lacrimal, 33 

Ectropion forceps, 125 

illustrated, 125 
Eczema, 67. 
Elbow splints, 82, 87 
Electric light, 74 
Electricity, 61 
Electrodes, 130 

illustrated, 130 
Emmetropic eye, 35-38 

illustrated, 35 
Emollients, 92 

list of, 92 
Enema, 73 

Enucleation of eyeball, 136 
spoon, 128 

illustrated, 127 
Ephedrin, 108 
Epispastics, 92 
Epithelium, 32 

Errors ot refraction, 35-42, 46 
Esrharotics, 91 

list of, 91 
Eserin sulphate, 75, 108 

description of, 108 
Ether, 74 
Eucain, 109 

Euphthalmia hydrochlorate, 109 
Eversion of lids, 53 

illustrated, 53, 54 
External rectus muscle, 30 
Extraction of cataract, 134 
Extra-ocular muscles, 30, 31 

illustrated, 30 

operation on, 133 
Eye drops, 47 



Eye speculum, 129 
illustrated, 130 
tray, 88 

contents of, 88 
illustrated, 88 
Eyeball, anatomy of, 23 
muscles of, 29 
removal of, 136 
Eyebrows, 31 
Eye-cup, 51 

illustrated, 52 
Eyelids, 31 

FARADIC electricity, 61 
Far-sighted astigmatism, 42 
eye, 35, 38 

illustrated, 36 
Far-sightedness, 29 
File, trachoma, 129 
illustrated, 130 
Fixation forceps, 126 

illustrated, 125 
Flatulence after eye operations, 

71 
Fluorescein, 110 
Forceps, advancement, 126 
illustrated, 125 
capsule, 126 

illustrated, 125 
cilia, 126 

illustrated, 125 
ectropion, 125 

illustrated, 125 
fixation, 126 

illustrated, 125 
iris, 126 

illustrated, 125 
trachoma, 126 
illustrated, 125 
Foreign bodies in eye, 32 
body spud, 128 

illustrated, 127 



INDEX 



171 



Formaldehyd, 110 
Formalin, 110 
Fovea centralis, 26 
illustrated, 27 
Frontal bone, 22 

Galvanic electricity, 61 

Galvanocautery, 61 

General anesthetic, 74 75, 82, 

84 
Germicide, 92 
Gland, lacrimal, 33 
Glare, exposure of eyes to, 43, 

44 
Glaucoma, 55, 135 
Glossary, 137 
Glycerin, 111 
Gonorrhea, 68 

Gonorrheal conjunctivitis, 51 
Granulated lids, 59 

Hair, dressing of, 72 

illustrated, 72 
Heat, 55 
Hemorrhage, 82 

subconjunctival, 59 
Hemostatics, 92 
Holding the pipet, 50 

illustrated, 50 
Holocain, 111 

Homatropin hydrobromate, 112 
Hook, strabismus, 128 

illustrated, 127 
Hot packs, 54, 55 

after leaching, 63 

method of applying, 56 
of heating, 57 
illustrated, 56 
Humors of the eye, 26 
Hyaline membrane, 28 
Hydrogen peroxid, 112 
Hygiene of the eye, 43 



Hyoscin, 113 
Hyoscyamin, 113 
Hyperopia, 29 
Hyperopic eye, 35 
illustrated, 36 
Hypopyon, 132 

Iced compresses, 57, 58 
Improper light, 45 
Infancy, eyes in, 43, 44 
Infant's eyes, 43, 44 
Inferior oblique muscle, 31 
Inflammation of eyes, 55 
Injuries of the eyes, 55 
Instrument tray, 77 

illustrated, 77 
Instruments, care of, 76 

in operating room, 79 

ophthalmic, 124 

illustrated, 125, 127, 130 
Internal rectus muscle, 30 
Intra-ocular tension, massage for, 
60 
operation for, 132, 135 
Inunction, mercurial, 64 
Iodids of potash, 64 
Iodin tincture, 113 
Iodoform after enucleation, 82 

description of, 114 

ointment. 66 
Iridectomy, complications follow- 
ing, 84 

description of, 135 

dressings after, 80 

pain after, 85 
Iris, description of, 24, 25 

forceps, 126 
illustrated, 125 

operation on, 135 

relation of aqueous to, 26, 27 
Irregular astigmatism, 42 
Irrigator, author's, 69 



172 



INDEX 



Irritants, definition of, 92 

list of, 92 
Itrol, 114 

Keratitis, 55 
Keratome, 126 

illustrated, 127 
Knapp dressing, 80 
illustrated, 80 
Knife, Beer's, 126 
illustrated, 127 
canaliculus, 127 

illustrated, 127 
cataract, 126 

illustrated, 127 
needle, 127 

illustrated, 127 

paracentesis, 128 

illustrated, 127 

Lacrimal apparatus, 33 

illustrated, 33 
bone, 22 
dilator, 128 

illustrated, 127 
duct, 33 
gland, 32, 33 
probe, 128 

illustrated, 127 
puncta, 33 
sac, 33 
secretion, 33 
syringe, 128 

illustrated, 127 
Lashes, 32, 73 
Lead acetate, 114 
Leeches, 62 

application of, 62 
artificial, 63, 129 

illustrated, 63, 127 
bite, 63 
illustrated, 62 



Length of eye in refractive cases, 

illustrated, 36 
Lens capsule, 27, 39 

crystalline, 25, 27, 35, 39 
illustrated, 27 

scoop, 128 

illustrated, 127 
Leucorrhea cause of eye diseases, 

68 
Lids, description of, 31, 34 

eversion of, 53 

illustrated, 53, 54, 55 

operation on, 133 

retractors, 129 
illustrated, 130 
Light, electric, 74 

exposure to, 43, 44 

improper, 45 
Liquid diet, 87 
Local anesthetics, 82 

list of, 90 
L\ mphagogues, 93 

list of, 93 
Lymphatic circulation, 59 

M lcula lutea, 26 

illustrated, frofitispiece 
Magnet, 129 

illustrated, 130 
Malar bone, 22 
Management of children, 49, 50 

illustrated, 49 
Massage, 59 

Materia medica, ophthalmic, 90 
Meibomian gland, 32 

illustrated, 33 
Menstruation, 71 
Mercurial inunction, 64 

ointment, 1 14 
Mercury bichlorid, 66, 73, 74, 78 

description, 115 
cyanid, 115 



INDEX 



173 



Mercury, yellow oxid, 115 
Micro-organisms, 68, 90 
Mixed astigmatism, 42 

illustrated, 41 
Moist heat, 55, 56 
Muscle of accommodation, 37 
Muscles, operations on, 133 
Muscular errors, 46 
Mustard, 116 

blister, 63 
Mydriatics, definition of, 93 

list of, 93 

pipet used for, 51 

to produce rest of eye, 65 
Mydrin, 116 
Myopia, 40, 44, 45 

progressive, 40, 42, 45 
Myopic eye, 35 

illustrated, 35 
Myotics, 93 

list of, 93 

Narcotics, 71 

Nargol, 116 

Nausea, 85 

Near-sighted astigmatism, 42 

Near-sightedness, 35, 37, 38, 40 

causes of, 44, 45 

illustrated, 35 

progressive, 42, 45 
Needle, 130 

holder, 129 

illustrated, 130 

illustrated, 130 

knife, 127 

illustrated, 127 

tattoo, 129 

illustrated, 130 
Needling operation, 134 
Nerve centers, 30 

head, 26 
Neuralgia, supra-orbital, 61 



Nitrate of silver, 66, 116 
Novocain, 116 
Nurse and physician, 21 
Nutrition of cornea, 55, 57 

Oblique muscle, 30 
Ocular hygiene, 43 
massage, 59 
illustrated, 60 
Ointments, 58 
Old sight, 39 
Olive oil, 117 

Opacities of the cornea, 59, 132 
Operating room at the home, 
74 
nurses duties in, 79 
table, 74 
Operations on the cornea, 132 
on the external ocular muscles, 

133 
on the eye, 55, 132 
on the iris, 135 
on the lens, 134 
on the lid, 133 
on the sclera, 135 
Operative nursing, 71 

technic, 79 
Ophthalmia neonatorum, 43, 68, 
69 
cause of, 43 
prevention, 69 
sympathetic, 64 
Ophthalmic instruments, 76 
description, 124-131 
illustrated, 125, 127, 130 
preparation of, 76 
materia medica, 90 
operations, description, 132 
Ophthalmoscope, 131 
Optic nerve, 23, 26 
illustrated, 24 
Orbit, 22 



174 



INDEX 



Orbit, illustrated, 22 
Organic heart affections, 65 

Pain after cataract operations, 85 

massage for, 59 
Palate bone, 22 
Palpebral conjunctiva, 32 
Papilla, 26 

Paracentesis knife, 128 
illustrated, 127 
of cornea, 132 
Pathologic specimens, 83 
Physician and nurse, 21 
Physiology of the eye, 35 
Pilocarpin, description of, 117 

for diaphoresis, 65 
Pipet, 50, 51 

method of holding, illustrated, 
50 
Poisonous solutions, 48, 52 

method of instilling, illus- 
trated, 48 
Poor print, 45 
Posterior chamber, 25 
ciliary arteries, 24 

nerves, 24 
sclerotomy, 135 
Postoperative nursing, 84 
Potassium iodid, 64 

permanganate, 117 
Poultices, 59 
Powders, 59 

Practical ophthalmic nursing, 47 
Pregnancy, 71 

Preparation of instruments, 76, 
77 
of patient, 72, 79 
Presbyopia, 39 
Pressure bandage, 81 
Print, 45 

Probe, lacrimal, 128 
illustrated, 127 



Progressive myopia, 40, 45 

near-sightedness, 40, 45 
Prolapse of iris, 86 
Protargol, 118 
Protection bandage, 81 

from bright light, 44 
Ptyalism, 64 
Puncta clamp, 131 
author's, 107 
illustrated, 107, 130 

lacrimal, 33, 34 
Pupil, 25, 28, 29 

artificial, 135 
Pupillomotor, illustrated, 29 
Purgatives, 73 
Purulent cases, 66, 67, 68 
Pus, 51, 68 
Pustulants, 92 
Pyoctanin, 118 

Reading in recumbent position, 
46 

Recti muscles, 30 

R( tractive errors, 35, 42, 46 

Refrigerants, 93 

Relation of nurse to physician, 21 

Removal of eyeball, 136 

Requisites of a successful nurse, 

17 
Rest, 65 
Retina, 25, 26 
Retinal detachment, 40 

illustrated, 39 
Retractor, lid, 129 

illustrated, 130 
Rose-water, 118 
Rubefacients, 93 

Sac, lacrimal, 33 
Saemisch's section, 132 
Sanguine temperment, 28 
Scalpel, 126 



INDEX 



i7S 






Scalpel, illustrated, 127 
Scarlet fever, 52 
School life, 44 
Scissors, enucleation, 124 
illustrated, 125 
iris, 124 

illustrated, 125 
tenotomy, 124 
illustrated, 125 
Sclera, 23, 30, 31 

operations on, 135 
Scoop, chalazion, 128 
illustrated, 127 
lens, 128 

illustrated, 127 
Scopolamin hydrobromate, 118 
Secondary cataract operation, 

134 
Secretion, 54 
Sedative, 93 
Shield, aluminum, 129 

illustrated, 127 
Shock, 85 
Silver citrate, 114 

nitrate, description, 118 
in purulent cases, 66, 70 
Simple far-sighted astigmatism, 
42 
illustrated, 40 
near-sighted astigmatism, 42 
illustrated, 40 
Skin troubles, 71 
Sleep, 65 
Sneezing, 85 

Sodium bicarbonate, 119 
borate, 119 
chlorid, 119 
Solutions, 48, 50, 77 
in eye, 47 
poisonous, 52 
Spatula, 129 
illustrated, 130 



Specific cases, 64 
Speculum, eye, 129 
illustrated, 130 
Splints, elbow, 82, 87 
Spoon, enucleation, 128 

illustrated, 127 
Spud, foreign body, 128 

illustrated, 127 
Staining agents, 93 

list of, 94 
Steam heat, 78 
Sterilization of hands, 78 
Stimulants, 94 

list of, 94 
Stooping position, 45 
Strabismometer, 129 

illustrated, 130 
Strabismus, 44 
hook, 128 

illustrated, 127 
Styptics, 94 

Subconjunctival hemorrhage, 59 
Sulphonai, 65 

Superior maxillary bone, 22 
oblique muscle, 31 
rectus muscle, 31 
Suppositories, 74 
Suppuration, 86 
Supra-orbital neuralgia, 61 

ridge, 33 
Suture, silk, 130 

illustrated, 130 
Sweating, 65 

Sympathetic ophthalmia, 64 
Synopsis of text matter, 121 
Syringe, lacrimal, 128 
illustrated, 127 
soft-rubber bulb, 131 
illustrated, 130 

Table, operating, 74 
Tannic acid, 120 



176 



INDEX 



Tattoo needle, 129 

illustrated, 130 
Tattooing of cornea, 132 
Tears, 32, 33, 48 
Tcchnic of operations, 79 
Temperament, sanguine, 28 
Temperature, 85 
Tenotomy, 133 
Tension of eye, 55, 59, 132 
Test-drum, 76, 77, 131 

illustrated, 76, 130 
Trachoma, 59 
file, 129 

illustrated, 
forceps, 126 

illustrated, 
Traumatism, 55 
Tray, eye, 88 

instrument, 77 
Tunics of the eye, 23 



130 



125 



Ulceration of cornea due to sil- 
ver nitrate, 69 

heat for, 55 

operation for, 132 
Urination after operation, 87 
Uveal tract, 24 

Vaselin, 120 
Vasoconstrictors, 94 

list of, 94 
Vasodilators, 94 

list of, 94 
Venae vorticosae, 23 
Vesicants, 94 
Vessels of conjunctiva, 32 
Visual purple, 25 
Vitreous, 25, 28 
Vomiting, 85 

Zinc sulphate, 120 



